Contrast agents are among the most frequently used drugs in medical practice. The aim of our study was to evaluate the incidence of complications associated with the use of different contrast agents in an angiography lab dedicated to pediatric patients with congenital heart disease. Between June 2015 and December 2017, 166 patients with congenital heart disease were diagnosed and/or treated in the angiography lab. Of these patients, 38 were excluded because they did not require contrast substance administration. As interventional procedures we performed pulmonary valvular dilatation in 17 cases (10.2%), stent implantation in coarctation of the aorta in 9 cases (5.4%), PDA closure in 62 cases (37.3%), atrial septal defect (ASD) closure in 36 patients (including patients without contrast agent�s administration) (21.7%). In the group of 129 patients who received contrast agents, the median age was 5.8 years (range 0.1-19 years) and median weight 22.8 kg (range 2.8-72 kg). Average consumption of contrast media per procedure was 79 ml/procedure (range 5 - 400 mL) and 4.3 mL/kg (range 0.4 - 22.7). We used iomeprol (24%), iohexol (8.5%), iopromide (67.4%). No contrast related complications are reported in this group. In conclusion, the contrast agents we used seem to be safe and are not associated with renal complications.
Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3–25 years) and median weight 25 kg (range 11.5–63 kg). The mean follow-up was 17.4 ± 6.7 months (range 3–26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ± 4.1 mm (range 8–26 mm). The mean device diameter used was 17.3 ± 5.6 mm (range 8–32 mm). Regarding the PDA closure, the median age was 36 months (range 4–192 months) and median weight 14 kg (range 5–58 kg). The mean follow-up was 15 ± 8 months (range 3–28 months). The mean PDA minimum diameter was 2.5 ± 0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3–28 months), no device-related complications were noted.The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.
Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.
Starting a paediatric interventional cardiology program in a developing country like Romania is not an easy task to accomplish. The tremendous need for treating children in order to reduce the morbidity and mortality in paediatric population with congenital heart disease was the main purpose for this project.MethodsIn 2015 we succeeded to implement such a program with the help of the Ministry of Health and the National Insurance House, on one hand and with the help of the Italian Team from the Bambini Cardiopatici nel Mondo on the other hand.ResultsBetween June 2015 and January 2017, 100 cases of congenital heart diseases were diagnosed and treated in the Compartment of Interventional Cardiology of the ‘Marie Curie’ Emergency Children’s Hospital. From these cases 79% were interventional cases and 21% diagnostic cases. Of all cases 21% were atrial septal defect (ASD) closures using Cocoon Atrial Septal Occluder, 33% were patent ductus arteriosus (PDA) closures using Cocoon Duct Occluder, Oclutech Duct Occluder, PFM coil and Flipper Coil. 18% beneficiated of pulmonary valve dilatation using both Tyshak and Osypka balloons, 5% of all were aortic coarctation with stent implantation using CP Stent Bare or Covered, and 2% were Rashkind atrioseptostomy. 5% were done in children with Down syndrome. 8% were performed in cases of pulmonary hypertension. 11% were done in children less than 1-year-old. The complication and failures rate for the first 100 cases was 5% (most important – ASD device embolization, two failures of pulmonary valve dilatation, one PDA device 4/6 mm withdrawal and changed to a 6/8 mm dimension device).ConclusionAfter 100 cases performed in our institution the early and intermediate results are very encouraging and are similar with other results reported in the current literature.
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