In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.

No abstract

Objective-To report initial experiences with transcatheter occlusion of atrial septal defects using a new occlusion device.

The prenatal detection of a right-sided aortic arch achieved mainly by targeted visualization of the threevessel and three vessels and trachea (3VT) view, with or without color Doppler, has been discussed recently in this journal 1 -4 .Two typical forms of a right aortic arch can be distinguished 5,6 . In one condition a vascular ring is found around the trachea, the so-called U-sign prenatally ( Figure 1) 2,3 . The trachea and esophagus are entrapped between the right aortic arch and the left ductus arteriosus and this abnormality is often an isolated incidental finding prenatally 2 . In the other condition, both the aorta and ductus arteriosus lie to the right of the trachea without a vascular ring. This condition is very commonly associated with cardiac anomalies 5 .The branching pattern of the great vessels arising from the aortic arch in both conditions is of major interest in pediatric cardiology 5,6 . The right aortic arch without a vascular ring usually exhibits mirror image branching of the arteries with the left innominate (brachiocephalic) artery arising first followed by the right common carotid and right subclavian artery 6 . By contrast, the right aortic arch with vascular ring very often has an association with an aberrant left subclavian artery. The left common carotid arises first from the aortic arch, followed by the right common carotid, right subclavian artery, and finally a retroesophageal vessel segment from which the left subclavian artery arises and the ductus arteriosus connects. The retroesophageal (and retrotracheal) vessel segment is known as the diverticulum of Kommerell. In other words, the left subclavian artery is connected ventrally to the ductus arteriosus arising from the left pulmonary artery, and dorsally through the Kommerell's diverticulum to the descending aorta. In postnatal life, after closure of the ductus arteriosus, blood enters the left subclavian artery via the descending aorta and Kommerell's diverticulum 4 .Prenatal assessment of a right-sided aortic arch and its branching pattern requires scanning in such planes as a transverse 3VT view (Figure 1 planes and coronal longitudinal views ventrally from the spine. In the latter planes, the aortic arch lies to the right of the trachea, and the connection with the diverticulum of Kommerell is recognized as a Y-shaped structure dorsal to the trachea (Figure 2) 2,4 . The cephalic vessels arising from the aortic arch can be visualized in more ventral planes, but because of their horizontal course the use of power Doppler ultrasound, which is superior to color Doppler in such insonation conditions, is advised.

Objectives: Because data for neonates are limited, optimal management of critical aortic stenosis remains controversial (balloon valvotomy [BV] or open valvoplasty [OV]). In a center with balanced experience in both methods, we hypothesized that OV can provide a better individualized approach than blunt BV and better serve long-term outcomes.Methods: A retrospective review of data and follow-up (survival, freedom from operation/replacement) of all neonates, suitable for biventricular repair, undergoing aortic valve procedure , was performed.