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Percutaneous closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation.

Background Cardiac catheterization remains the standard diagnostic technique for assessing both anatomy and physiology in congenital heart disease (Chd). fixed projection angiography (fpa) is the mainstay for guiding congenital cardiovascular interventions. however, fpa has limitations in soft tissue visualization and precise characterization of complex structures such as segmental branch pulmonary arteries, coronary arteries, and anomalous or stenotic pulmonary veins. these limitations are due in part to simultaneous opacification of overlying structures, foreshortening of structures if the projection is not perfectly aligned, and the inability to visualize structures without injection of contrast. integration of 3-dimensional (3d) image data sets with fluoroscopy can potentially overcome limitations of 2-dimensional (2d) angiography for visualizing complex vascular structures and can facilitate accurate diagnoses as well as guide interventional procedures. the use of 3d images obtained from 3d rotational angiography (3dra), Ct, and Mri was originally developed for neuroradiographic endovascular procedures 1-3 but has played an increasing role in cardiovascular medicine for anatomic delineation 4-7 and electroanatomic mapping. 8 rotational angiography (ra) and 3dra have emerged as promising modalities applicable to congenital cardiac diagnosis. 7, 9 additionally, integrated 3d images from 3dra, Ct, and Mri overlaid onto live fluoroscopy are now being used for roadmaps to guide Chd diagnostic and interventional procedures. 5, 6, 10 the potential benefits of integrating 3d images into fluoroscopic procedures for Chd are many, including: (1) improved diagnostic and interventional efficacy, (2) reduced overall radiation exposure, (3) reduced contrast dose, and (4) reduced procedural time. 11-13 all of these are particularly advantageous in the pediatric population. parallel to this, 3d transesophageal echocardiography (3d-tee) is currently being applied to Chd catheterization procedures. this technology allows real-time anatomic visualization of soft tissue structures and catheter guidance within the beating heart.

Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine whether similar benefits can be extended to other types of diagnostic and complex interventional procedures.

Objective: Our aim was to evaluate left ventricular (LV) mechanics by using speckle tracking echocardiography (STE) in asymptomatic patients with abnormal origin of the left main coronary artery from the pulmonary trunk (ALCAPA), late after successful repair, in the presence of LV ejection fraction (EF) >50%. Methods: We studied 30 ALCAPA patients (median age 4 years, range 1-25 years, NYHA class I, LVEF >50%) and 16 healthy age- and sex-matched controls (median age 5 years, range 1-25 years). All underwent standard echocardiographic evaluation and STE. Results: LV dimensions and LVEF (63.6 ± 8.2% vs. 64.1 ± 5.1%, p = 0.826) were not different between patients and controls. Diastolic parameters were significantly abnormal in our patients versus controls (E/e' average: 11.9 ± 5.8 vs. 6.6 ± 3.0, p = 0.0014). Global LV longitudinal strain was significantly lower in ALCAPA patients versus controls (-17.6 ± 3.5% vs. -23.4 ± 3.1%, p < 0.0001). LV torsion (9.1 ± 4.9° vs. 11.9 ± 3.3°, p = 0.046) was significantly impaired in ALCAPA patients. Conclusions: After successful repair in asymptomatic ALCAPA patients, despite an LVEF >50%, diastolic function, LV longitudinal deformation and LV torsion remain impaired. We suggest including a detailed study of the diastolic function and cardiac mechanics in the clinical follow-up of these patients to identify the subgroup of patients at higher risk.

This case illustrates a novel method of using the body of a ruptured balloon to protect subsequent balloons from rupture due to heavy conduit calcification. This method requires the presence of two venous access lines but might save time, effort, and cost from repeated balloon ruptures.

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