No abstract

Transcatheter closure of atrial septal defects in infants can be safe, effective, and may be indicated for situations in which the left to right shunt may be implicated as a cause of ongoing chronic lung disease. Moderate increases in pulmonary blood flow due to atrial septal defects may have a negative clinical impact regarding continuing respiratory insufficiency in these patients.

The use of catheter-based techniques for the treatment of BTS occlusion is highly successful, and potentially avoids high-risk re-operative intervention. ECMO can provide for a stable patient during the procedure. Hopefully, with improved technology and innovative procedures, more children in the future with BTS occlusion can be served by successful percutaneous intervention.

No abstract

Catheter closure of atrial septal defects (ASDs) is an accepted procedure among pediatric cardiologists. We report our early experience with the newest of these devices in clinical trials in the United States. Between April and October 2001, 14 patients were enrolled in an FDA phase II multicenter trial comparing the results of ASD closure using the HELEX Septal Occluder to a surgical control group. Of the 14 patients, devices were placed and left in 13, one being removed for an excessive residual leak despite placing the largest device available. Of the remaining 13 patients, all patients had successful closure of their defects. An average of 1.8 devices/patient were deployed, reflecting the learning curve for this new device and new delivery style. Six devices were replaced because of excessive residual leaks, three for premature lock release, and two for improper seating of the device. There were no procedural complications, however, one patient required device removal 4 months postimplant for possible allergic reaction to nickel. The same patient had removal of stainless steel sternal wires for the same reason. At the 6-month follow-up, 11 of 13 patients had complete closure of the ASD, the other two having small, hemodynamically insignificant left to right shunts. In one of these patients, there was complete closure at the 12-month follow-up, whereas the other patient awaits the 1-year evaluation. Early experience at our institution has demonstrated the ease of use of this device, its complete retrievability, and excellent closure of small to moderate ASDs in children.

No abstract

Clinical assessment of systemic perfusion in single ventricle patients with parallel circulation can be difficult in the outpatient setting. Near infrared spectroscopy (NIRS) is a noninvasive measure of cerebral oximetry. We measured vital signs, pulse oximetry, and NIRS in 20 single ventricle patients with parallel circulation prior to routine cardiac catheterization. These variables were evaluated to determine the best noninvasive predictor of the superior vena cava saturation (SVC(sat)) as a marker for the adequacy of systemic oxygen delivery. The mean age was 6.7 months [standard deviation (SD), 8.6] and mean weight was 6.5 kg (SD, 2.2). Diagnoses were hypoplastic left heart syndrome (8), tricuspid or pulmonary atresia (10), and double-outlet right ventricle variants (2), all prior to cavo pulmonary anastomoses or complete repairs. Stepwise multiple regression analysis generated a model in which only NIRS was a significant independent predictor of SVC(sat) (p = 0.009). These results support the conclusion that NIRS can be a useful tool to evaluate awake single ventricle patients in the outpatient setting.

No abstract