Minimally invasive strategies can be expanded by combining standard surgical and interventional techniques. We performed a longitudinal prospective study of all pediatric patients who have undergone hybrid cardiac surgery at the TJniversity of Chicago Children's Hospital. Hybrid cardiac surgery was defined as combined catheter-based and surgical interventions in either one setting or in a planned sequential fashion within 24 hours. Between June 2000 and June 2003, 25 patients were treated wilh hybrid approaches. Seventeen patients with muscular ventricular septal defects (mVSDs) (mean age, 4 months; range, 2 weeks-4 years) underwent either sequential Amplatzer device closure in the catheterization laboratory followed by surgieal completion (group IA, n ^ 9) or one-stage intraoperative olTpump device closure (group IB, n = 8) with subsequent repair of any concomitant heart lesions. Eight patients with branch pulmonary artery (PA) stenoses (group 2) underwent intraoperative PA stenting or stent balloon dilatation along with concomitant surgieal procedures. All patients survived hospitalization. Complications from the hybrid approach were mostly confined to groups IA and 2. At a mean follow-up of 18 months, 2 group IA patients died suddenly several months after discharge. All other patients are doing well. Hybrid pediatric cardiac surgery performed in tandem by surgeons and cardiologists is safe and effective in reducing or eliminating cardiopulmonary bypass. Patients with mVSDs who are small, have poor vascular access, or have concomitant cardiac lesions are currently treated in one setting with the pcrventricular approach.Although surgery remains the treatment of choice for most congenital cardiac malformations, interventional cardiology approaches are increasingly being Correspondence uehieago.edu to: E.A. Bacha, email: ebacha(a;surgery.bsd.
Transcatheter closure of atrial septal defects is an established practice. The imaging method best suited for guidance of this procedure is under debate. This review highlights the areas of disagreement and presents available evidence supporting the contention that intracardiac echocardiography is at least as good, if not a superior imaging method to guide the procedure. Points of discussion include comparisons of imaging capability, complications or discomfort, and the relative costs of these procedures. It is concluded that intracardiac echocardiography is the superior imaging method.
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