Pediatric catheter interventions: a year in review 2004-2005

Patel, Hitendra; Hijazi, Ziyad M.

doi:10.1097/01.mop.0000172813.56766.52

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…First, adult grown-up patients with surgically repaired CHD are a large and growing population, estimated to be one million in US in the year 2000, compared with an estimated 300 000 in 1980, and 1.4 million are expected by 2020 39. Second, the long-term outcome of the underlying cardiac disease has been dramatically improved by interventions in the past decade, and now excellent long-term survival is the rule, rather than the exception 9 10. Third, and most importantly, children are several times more sensitive to radiation than middle-aged adults 1 3 11 12.…”

Section: Discussionmentioning

confidence: 99%

“…Trends indicate that worldwide population exposure from medical radiation is increasing2 3 and the use of procedures with a high radiation dose continues to grow steadily,4–8 especially in cardiology6 8—and particularly in paediatric cardiology 9. Children are at least four times more sensitive than adults to the induction of cancer, and the proliferation of appropriate and inappropriate examinations with high radiological dose in children has raised concern among the paediatric community10 and regulatory bodies 11 12.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease

Ait-Alì

Andreassi²,

Foffa

et al. 2009

Heart

200

152

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BackgroundThe seventh Committee on "Biological Effects of Ionizing Radiation" (BEIR VII, 2006) underlines "the need of studies of infants who are exposed to diagnostic radiation because catheters have been placed in their hearts". Objective To determine the lifetime attributable risk (LAR) of cancer associated with the estimated cumulative radiological dose in 59 children (42 male, age 2.863.2 years) with complex congenital heart disease, and to assess chromosomal DNA damage after cardiac catheterisation procedures. Methods In all patients, the cumulative exposure was estimated as effective dose in milliSievert (mSv), and LAR cancer was determined from the BEIR VII report. In a subset of 18 patients (13 male, age 5.265.7 years) micronucleus as a biomarker of DNA damage and longterm risk predictor of cancer was assayed before and 2 h after catheterisation procedures. Doseearea product (Gy cm 2 ) was assessed as a measure of patient dose. Results The median life time cumulative effective dose was 7.7 mSv per patient (range 4.6e41.2). Cardiac catheterisation procedures and CT were responsible for 95% of the total effective dose. For a 1-year-old child, the LAR cancer was 1 in 382 (25th to 75th centiles: 1 in 531 to 1 in 187) and 1 in 156 (25th to 75th centiles: 1 in 239 to 1 in 83) for male and female patients, respectively. Median micronucleus values increased significantly after the procedure in comparison with baseline (before 6& vs after 9&, p¼0.02). The median doseearea product value was 20 Gy cm 2 (range 1e277). Conclusion Children with congenital heart disease are exposed to a significant cumulative dose. Indirect cancer risk estimations and direct DNA data both emphasise the need for strict radiation dose optimisation in children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease

Ait-Alì

Andreassi²,

Foffa

et al. 2009

Heart

200

152

View full text Add to dashboard Cite

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“…Beyond open surgical approaches the optimal treatment also frequently comprises interventional techniques such as dilation of stenosis of the great arteries or closure of shunts [8,9]. Since C-Arm CT is capable of providing high quality 3D imaging in complex cases with usually lower radiation doses than conventional CT [19] this technique is more and more applied also in pediatric cardiology (Fig.…”

Section: C-arm Computed Tomography (C-arm Ct)mentioning

confidence: 99%

“…During the last decades various different disease entities have been discovered and for many of them also treatment options have been proposed. Further miniaturization of the devices has led to a trend towards less invasive therapies for coronary artery disease, valvular heart disease, congenital anomalies and cardiac arrhythmias [5][6][7][8][9][10]. Accurate imaging modalities are of paramount importance for the guidance of these complex interventional procedures in the cath lab.…”

Section: Introductionmentioning

confidence: 99%

New X-ray imaging modalities and their integration with intravascular imaging and interventions

Hetterich¹,

Redel

Lauritsch

et al. 2009

Int J Cardiovasc Imaging

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During recent years various techniques emerged providing more detailed images and insights in the cardiovascular system. C-Arm computed tomography is currently introduced in cardiac imaging offering the potential of three dimensional imaging of the coronary arteries, the cardiac chambers, venous system and a variety of anatomic anomalies inside the interventional environment. Furthermore it might enable perfusion imaging during percutaneous coronary intervention (PCI). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are meanwhile established tools for detailed assessment of the coronary arteries. Their use might further increase with automated tissue characterization, three dimensional reconstruction, integration in angiography systems, and new emerging techniques. Parameters of fluid tissue interactions are important factors in the pathogenesis of atherosclerosis. These parameters can be calculated using computational fluid dynamics based on three dimensional models of the coronary vessels which can be derived from various sources including multislice computed tomography (MSCT), C-Arm CT or 3D reconstructed IVUS or OCT. Their use in the clinical setting has yet to be determined especially with regard to their ability in increasing treatment efficiency and clinical outcome.

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“…Although cardiac catheterization played a major role in anatomic assessment in tetralogy of Fallot, catheterization is currently focused on anatomic details in more complex cyanotic lesions and interventional procedures to rehabilitate pulmonary arteries with balloons and stents in more severe forms of cyanotic heart disease. 7,8 Hybrid catheter in-terventional procedures simultaneously performed with surgical intervention have also addressed challenging issues in complex congenital heart disease. 9 There has also been great progress understanding the genetic contribution to tetralogy of Fallot and other congenital heart lesions.…”

Section: Progress and Advancesmentioning

confidence: 99%