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ABSTRACT: Objective: To describe the technical aspects and outcome of duct occlusion in adults over a 12-year period. Methods: A single center review of all transcatheter duct closures performed between 2000 and 2012. Results: Of 518 transcatheter duct closures performed, 31 patients were over the age of 16 at the time of procedure (6%). In 10 of the 31 cases, it was not possible to cross the duct from the pulmonary artery. In 4 of those, the duct was small enough to be closed with coils delivered from the aorta (although 1 required a second procedure for a residual shunt). In the remaining 6 cases, it was necessary to cross the duct from the aorta and create an arterio-venous "circuit" using a snare to deliver an Amplatzer device from the femoral vein. In none of the 487 children who underwent transcatheter duct closure during the same time period was it necessary to deliver the device using an arterio-venous wire circuit. The increased complexity of the procedure in adults compared with children was further reflected by longer procedure times (median of 37 minutes in adults vs. 24 minutes in children [P < 0.01]) and longer fluoroscopy times (median of 8.4 minutes in adults vs. 4.3 minutes in children [P < 0.025]). There were no major complications. Conclusions: Closure of the arterial duct in adults is safe and effective but ductal anatomy may differ from that seen in childhood, making transcatheter closure technically much more demanding than in children. (J Interven Cardiol 2012;25:501-504).
Journal of Interventional Cardiology 06/2012; 25(5):501-4. · 1.18 Impact Factor
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ABSTRACT: To evaluate the safety and efficacy of transcatheter occlusion of the arterial duct without femoral arterial catheterization.
Patent arterial ducts have been closed percutaneously since the 1960s. It remains standard practice to use arterial access for aortography before, during, and after implantation of the device. Femoral arterial catheterisation has well recognised complications, and should be avoided unless absolutely necessary.
We reviewed prospectively collected data relating to 389 occlusions of the arterial duct performed consecutively between 1994 and 2004. We inserted Cook detachable coils in 288 instances using the Amplatzer duct occluder in the remaining 101. Information was obtained regarding procedural success, displacement of the device, and re-intervention. We have followed out patients for a median of 1.15 years in those closed with the Amplatzer device, and 1.09 years in those closed with a coil.
In the patients in whom we used coils, occlusion was possible in 75% using venous access alone. We reintervened in 25 patients, because of embolisation of the device in 6, haemolysis in 5, and residual shunting in 14. On follow-up, complete occlusion had been achieved in 98%. We found trivial stenosis of the left pulmonary artery in 3 patients. When using the Amplatzer device, closure using venous access alone was achieved in 82%, and 2 patients required reintervention because of embolisation of the device. Complete occlusion had been achieved in all patients as judged by follow-up at 1 year, and 2 patients had trivial stenosis of the left pulmonary artery.
Arterial catheterisation is unnecessary in the great majority of patients undergoing occlusion of the arterial duct. Use of venous catheterisation alone is safe, and does not appear to increase the risk of device-related complications.
Cardiology in the Young 02/2010; 20(1):39-43. · 0.76 Impact Factor
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Cardiology in the Young 07/2008; 18(3):350. · 0.76 Impact Factor
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ABSTRACT: Dilated cardiomyopathy, hypertrophic cardiomyopathy, and cardiac rhythm disturbances are important features of certain neuromuscular disorders in children, adolescents, and young adults. This article summarizes the cardiac features seen in patients with Duchenne muscular dystrophy, Becker muscular dystrophy, myotonic dystrophy, Friedreich's ataxia, and Emery-Dreifuss muscular dystrophy. The optimal management of these cardiac features remains contentious, but increasingly these patients are referred for routine cardiological assessment in the absence of symptoms. This article examines the value of routine screening and drug interventions for cardiac complications in asymptomatic and symptomatic individuals with neuromuscular disorders. We recommend a pragmatic approach, actively looking for cardiac conditions which will benefit from early intervention, but avoiding routine screening for asymptomatic conditions in which there is no evidence of benefit from early intervention.
Developmental Medicine & Child Neurology 04/2006; 48(3):231-5. · 2.92 Impact Factor
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ABSTRACT: To assess the volume and range of diagnosis in new patients referred to paediatric cardiac outpatient clinics.
Data was collected prospectively, using a proforma completed at all outpatient clinics over a period of three months.
There were 526 new referrals, representing an increase of almost one-fifth compared to 5 years ago. Of the referrals, 78 percent came from hospital doctors, and 22 percent from general practitioners, with 221 of those referred being infants. A heart murmur was the most common reason for referral, representing almost two-thirds of cases. In 372 patients referred (71 percent), the heart was discovered to be structurally normal. The proportion of patients with normal hearts referred by general practitioners and hospital doctors were 81 percent, and 68 percent, respectively (p less than 0.004). There was considerable variation in the pattern of referral between doctors working in different hospitals.
New referrals to centres dealing with congenital cardiac malformations are increasing alarmingly, with the majority of the children referred having normal hearts. This increase in demand for specialist services has important implications for resources and training.
Cardiology in the Young 03/2005; 15(1):43-6. · 0.76 Impact Factor
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Cardiology in the Young 03/2003; 13(1):101-2. · 0.76 Impact Factor
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ABSTRACT: A child with nephrotic syndrome presenting with right heart failure and severe pulmonary hypertension due to pulmonary artery A child with nephrotic syndrome presenting with right heart failure and severe pulmonary hypertension due to pulmonary artery
thrombus was treated with locally administered streptokinase infusion. Streptokinase infusion was continued for 8 days, eventually thrombus was treated with locally administered streptokinase infusion. Streptokinase infusion was continued for 8 days, eventually
leading to complete dissolution of thrombus. leading to complete dissolution of thrombus.
Pediatric Nephrology 01/1996; 10(6):734-736. · 2.52 Impact Factor
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ABSTRACT: A hydropic neonate, born at 28 weeks gestation, died 45 minutes after birth. Autopsy showed an abnormally long and tortuous arterial duct which wasoccluded by laminated thrombus. The right heart chambers and the left ventricle were dilated, but there was no other structural cardiac abnormality. Apart from the abnormal ductal morphology, there was no evident cause for the intrauterine thrombosis of the arterial duct, which appeared to be the sole cause of fatal heart failure.
Cardiology in the Young 09/1994; 4(04):411 - 412. · 0.76 Impact Factor
