DOCSLIB.ORG

Balloon Atrial Septostomy Via the Umbilical Vein

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Balloon Atrial Septostomy Via the Umbilical Vein Br Heart J: first published as 10.1136/hrt.36.10.1040 on 1 October 1974. Downloaded from Case reports British Heart Journal, I974, 36, I040-IO4. Balloon atrial septostomy via the umbilical vein H. H. Kaye' and Michael Tynan From the Department ofCardiology, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne A case of transposition of the great arteries is presented in which an adequate balloon septostomy was per- formed through the umbilical vein. Some diffxiculty was experienced in traversing the ductus venosus. The possible complications of umbilical vein catheterization are reviewed but it is suggested that some of them may be avoided since the procedure is carried out under x-ray control. The outlook for children with transposition of the left ventricle, but this reverted spontaneously to sinus great arteries has improved in recent years. Balloon rhythm. A diagnosis of transposition of the great atrial septostomy (Rashkind and Miller, I966) has arteries with only an interatrial communication was made. shown to be the Bidirectional shunting was demonstrated before septo- been palliative treatment of choice stomy which could only have been taking place at atrial (Tynan, I97I) and considerable success has been level. An unsuccessful attempt was then made to intro- achieved by surgical correction (Clarkson et al., duce a 5 5 French Rashkind catheter into the right copyright. 1972), particularly in infancy (Breckenridge et al., femoral vein, and owing to extensive damage to the 1972). vein it had to be tied off. Because the baby's condition Technical difficulties, however, can be a problem had deteriorated, it was decided to attempt a balloon in the catheter room and some authors have drawn septostomy via the umbilical vein thus saving time and attention to this when discussing balloon atrial limiting further surgical trauma. A 5.5 French Rashkind septostomy via the femoral vein (Singh, Astley, and catheter was introduced into the umbilical vein at the Burrows, I969; umbilicus but could not be manipulated through the http://heart.bmj.com/ Venables, I970). ductus venosus. However, a 4 French Rashkind catheter In this report a case is described in which sep- was similarly introduced and manipulated into the left tostomy was performed through the umbilical vein, atrium with little difficulty. The atrial septostomy was as an alternative to the femoral route. performed and the procedure terminated. Three weeks later, because of poor clinical progress Case report and persistent cyanosis, a further cardiac catheterization A male infant, who had been born normally weighing was carried out; the results are shown in the Table. 3-8 kg, was transferred to Newcastle General There had been no significant rise in the aortic oxygen Hospital on September 30, 2021 by guest. Protected when he was i day old because ofpersistent cyanosis and saturation, but it was at the mean value for late post- dyspnoea. His condition at birth was good (Apgar Io) operative results quoted by Tynan (1972a), the left and but he had deteriorated from the age of 2 hours. right atrial mean pressures were similar, and the relation On examination he showed pronounced central between the aortic oxygen saturation and the pul- cyanosis and dyspnoea. His heart rate was 15o/min, both monary to systemic flow ratio suggested that an adequate heart sounds were palpable, but there were no audible atrial septal defect was present (Tynan, 1972b). murmurs. Chest x-ray showed a normal sized heart and One month after theoriginal investigation several signs plethoric lung fields. The electrocardiogram showed suggesting thromboembolism appeared. He was noticed sinus rhythm, a mean frontal QRS axis of + IIO, and to have a number of small areas of skin infarction on the right ventricular hypertrophy. right wrist and the left small toe, and at the same time Cardiac catheterization and angiocardiography were developed a left hemiparesis which has persisted. performed on the day of admission; the haemodynamic Subsequently the baby's condition slowly improved. data are shown in the Table. The diagnostic procedure Though he required considerable assistance with feed- was performed using a right saphenous vein cut down in ing initially, at the age of 6 months he was at home and the groin. It was complicated by an episode of complete gaining weight at a satisfactory rate. At follow-up he was heart block which occurred while the catheter was in the found to be moderately cyanosed but with no signs of heart failure. Chest x-ray showed only minimal cardiac 1 Present address: The Royal Aberdeen Children's Hospital, enlargement with no increase in pulmonary plethora and Foresterhill, Aberdeen. an electrocardiogram showed an expected degree ofright Br Heart J: first published as 10.1136/hrt.36.10.1040 on 1 October 1974. Downloaded from Transumbilical balloon septostomy 1041 TABLE Cardiac catheterization data point out that there is no evidence that they were directly related to the umbilical vein catheteriza- Before Three weeks tion. Enterocolitis and perforation of the bowel are septostomy after sepiostomy now well-recognized complications of exchange transfusion via the umbilical vein. Their aetiology, Oxygen saturations however, remains obscure (Hey, Ellis, and Walker, Aorta 57% 59% Superior vena cava 47% 43% I972) but it is relevant to note one of the cases de- Right atrium 46% 59% scribed by Orme and Eades (I968) in which in- Pulmonary artery 86% 88% testinal perforation occurred following continuous Pulmonary vein 95% 96% infusion of dextrose via the umbilical vein. If retro- Left atrium 83% 96% grade injection of solutions into the portal vein play Pulmonary: systemic a part in the aetiology of this condition, the risk flow ratio I: I 2: I should be decreased if the procedure is carried out under x-ray control. However, even with the help Mean pressures Left atrium 3 mmHg 5 mmHg of x-rays, local damage to the vein may occur Right atrium I mmHg 5 mmHg during catheter insertion. This was probably the cause of the umbilical arteriovenous fistula de- scribed by Reagan, James, and Dutton (1970). Such damage may easily be caused using the relatively ventricular hypertrophy for transposition of the great large and stiff Rashkind catheter. arteries. Transumbilical balloon atrial septostomy has been performed at two centres in Israel (Abinader, Discussion Zeltzer, and Riss, I970; Romney, Katzuni, and Catheterization of the umbilical vein is commonly Aygen, 1972). To our knowledge the case de- employed in neonatal practice for therapeutic pur- scribed above is the first British report and taken copyright. poses but the use of this route in the diagnosis of together with the previous reports, demonstrates congenital heart disease has seldom been described. the possibility of performing an adequate balloon Linde et al. (i966) investigated 50 neonates and septostomy using the umbilical vein as an alterna- were unable to reach the heart in 36 per cent of tive to the femoral route. In view of the possibility cases under the age of 6 days. The difficulty was of serious complications following even short-term encountered, as in our case, when trying to traverse umbilical vein catheterization, it is not recom- the ductus venosus. mended that this route be used as a routine. http://heart.bmj.com/ Complications of therapeutic umbilical vein cath- eterization have been reported frequently: Syman- sky and Fox (I972) found an overall complication References rate of 35 per cent. The incidence of bacterial col- onization of the catheter, with its accompanying Abinader, E., Zeltzer, M., and Riss, E. (I970). Transumbilical atrial septostomy in the newborn. American Journal of risk of local or systemic infection, does not appear to Diseases of Children, 119, 354. be related to the duration of catheterization (Balag- Balagtas, R. C., Bell, C. E., Edwards, L. D., and Levin, S. seems Risk oflocal and systemic infections associated with tas et al., I97i), and it likely that organisms (I97i). on September 30, 2021 by guest. Protected are introduced when the catheter is inserted. When umbilical vein catheterization; a prospective study in 86 newborn patients. Pediatrics, 48, 359. considering the use of this route the special risks of Breckenridge, I. M., Oelert, H., Stark, J., Graham, G. R., bacteraemia in infants with congenital heart disease Bonham-Carter, R. E., and Waterston, D. J. (I972). should be taken into account. There appears to be Mustard's operation for transposition of the great arteries. conflicting evidence concerning the relation be- Review of 200 cases. Lancet, I, II40. Clarkson, P. M., Barratt-Boyes, B. G., Neutze, J. M., and tween thrombosis of the umbilical vein and its Lowe, J. B. (I972). Results over a ten-year period of immediate connexions and the length of time that palliation followed by corrective surgery for complete the catheter is in place (Laroche, I970; Symansky transposition of the great arteries. Circulation, 45, 125I. and Fox, I972), but there is no doubt that umbilical Hey, E. N., Ellis, M. I., and Walker, W. (1972). Ileocolitis after exchange transfusion. Lancer, I, 266. vein catheterization can lead to pulmonary em- Laroche, J. C. (1970). Umbilical catheterisation; its compli- bolism (Scott, I965) and portal phlebitis or portal cations. Biology of the Neonate, I6, IOI. vein thrombosis which may be followed by portal Linde, L. M., Higashino, S. M., Berman, G., Sapin, S. O., hypertension (Tizard, I962) or hepatic necrosis and Emmanouilides, G. C. (I966). Umbilical vessel cardiac catheterization and angiocardiography. Circulation, 34, 984. (Scott, i965). Orme, R. L. E., and Eades, S. M. (I968). Perforation of the We wish to draw attention to the occurrence of bowel in the newborn as a complication of exchange thromboembolic complications in our case, but transfusion. British MedicalJournal, 4, 349. Br Heart J: first published as 10.1136/hrt.36.10.1040 on 1 October 1974.
Load more

Recommended publications
  • Cardiology Today Jan-Feb 2019.Pdf
    VOLUME XXIII No. 1 JANUARY-FEBRUARY 2019 PAGES 1-40 Rs. 1700/- ISSN 0971-9172 RNI No. 66903/97 www.cimsasia .com Cardiology MANAGING DIRECTOR & PUBLISHER Dr. Monica Bhatia TODAY EDITOR IN CHIEF OP Yadava SECTION EDITORS SR Mittal (ECG, CPC), David Colquhou n (Reader’s Choice) EDITORIAL NATIONAL EDITORIAL ADVISORY BOARD Circadian Rhythm of the Body - Is it the Holy Arun K Purohit, Arun Malhotra, Ashok Seth, Grail ? 3 Ashwin B Mehta, CN Manjunath, DS Gambhir, OP YADAVA GS Sainani, Harshad R Gandhi, I Sathyamurthy, Jagdish Hiremath, JPS Sawhney, KK Talwar, K Srinath Reddy, KP Misra, ML Bhatia, Mohan Bhargava, MR Girinath, Mukul Misra, Nakul Sinha, PC Manoria, Peeyush Jain, Praveen Jain, Ramesh Arora, Ravi R Kasliwal, S Jalal, S Padmavati, Satyavan Sharma, SS Ramesh, Sunil Kumar Modi, Yatin Mehta, Yogesh Varma, R Aggarwala. INTERNATIONAL EDITORIAL ADVISORY BOARD REVIEW ARTICLE Andrew M Tonkin, Bhagwan Koirala, Carlos A Mestres, Chuen N Lee, David M Colquhoun, Davendra Mehta, Contrast Induced Nephropathy: How to Enas A Enas, Gerald M Pohost, Glen Van Arsdell, Indranill Basu Ray, James B Peter, James F Benenati, Predict and Prevent? 5 Kanu Chatterjee, Noe A Babilonia, Pascal R Vouhe, RAGHAV BANSAL, VIVEKA KUMAR Paul A Levine, Paul Simon, P K Shah, Prakash Deedwania, Salim Yusuf, Samin K Sharma, Sanjeev Saxena, Sanjiv Kaul, Yutaka Imoto. DESK EDITOR Gandhali DESIGNER A run Kharkwal REVIEW ARTICLE OFFICES CIMS Medica India Pvt Ltd How do I Manage My Patients with Heart (Previously known as UBM Medica India Pvt Ltd.) Failure with Preserved Ejection Fraction? 10 Registered Office MOHAMMED SADIQ AZAM, DAYASAGAR RAO V Margosa Building, No.
    [Show full text]
  • Cardiac Arrhythmias Following the Creation Ofan Atrial Septal Defect in Patients with Transposition of the Great Arteries
    Thorax: first published as 10.1136/thx.28.2.147 on 1 March 1973. Downloaded from Thorax (1973), 28, 147. Cardiac arrhythmias following the creation of an atrial septal defect in patients with transposition of the great arteries R. J. MOENE, J. P. ROOS, and A. EYGELAAR Departments of Paediatric Cardiology and Cardiology, Free University Hospital, Amsterdam, and the Department of Thoracic Surgery, University Hospital, Groningen, The Netherlands In 64 children with transposition of the great arteries who underwent a Blalock-Hanlon pro- cedure, pre- and postoperative electrocardiograms were studied regarding the incidence and nature of rhythm disturbances. In another group of 19 patients with transposition of the great arteries, the atrial septal defect was created by a different surgical technique (fossa ovalis resection); this group was studied in the same way and the results were compared. After the Blalock-Hanlon procedure seven patients developed arrhythmias including atrio- ventricular (A-V) dissociation, wandering pacemaker, bradycardia, atrial flutter, supraventricular tachycardia, supraventricular premature beats, and ectopic atrial rhythm. After fossa ovalis resection rhythm disturbances were present in three patients. Despite their relatively high incidence it seems unlikely that arrhythmias are a major factor copyright. contributing to death irrespective of the technique used; some arrhythmias are transient and serious disturbances of long duration are rare. In complete transposition of the great arteries the tion) using temporary
    [Show full text]
  • Dye Dilution Curves After the Artificial Atrial Septostomy in Three Infants with the Transposition of the Great Vessels
    Pohoku J. exp. Med., 1970, 100, 39-46 Dye Dilution Curves after the Artificial Atrial Septostomy in Three Infants with the Transposition of the Great Vessels Hiroshi Onoki, Tetsuo Sato, Ichiki Kano and Keiko Mochizuki Department of Pediatrics (Prof. Ts. Arakawa), Faculty of Medicine, Tohoku University, Sendai Hemodynamic consequences after the Rashkind and Miller balloon atrial septostomy were successfully evaluated by means of the dye dilution technic in three infants with the complete transposition of the great vessels. The complete transposition of the great vessels has been the most common cause of death in infants born with congenital malformations of the heart; accord ing to Boesen1 forty-two per cent of the patients with this anomaly succumbed within one month of life and seventy-three per cent within the first three months of life. In 1964 Mustard2 reported a case of the transposition of the great vessels in which the successful result of the radical operation was obtained by adopting a two-stage correction technic; that is, creation of an atrial septal defect was done by Blalock-Hanlon's procedure with thoracotomy when 20 days of life, then successful radical operation was carried out at the age of 18 months. In 1966 Rashkind and Miller3 devised a method for the creation of an atrial septal defect without thoracotomy as a palliative approach to the complete transposi tion of the great vessels. Then in 1968, Rashkind and Miller4 reported thirty-one infants with the transposition of the great vessels who were subjected to the balloon atrial septostomy of theirs with a marked improvement in the interatrial blood commu nication.
    [Show full text]
  • Cardiac Surgery in Early Infancy J
    Postgrad Med J: first published as 10.1136/pgmj.48.562.478 on 1 August 1972. Downloaded from Postgraduate Medical Journal (August 1972) 48, 478-485. Cardiac surgery in early infancy J. STARK M.D. Hospital for Sick Children, Great Ormond Street, London, W.C. 1 IMPORTANT advances have been made in the diagnosis and treatment of congenital heart disease (CHD) in early infancy. Accurate diagnosis is now possible in the first days or even hours of life. Operation is also 3530- possible at this early age and very often it provides 0 the only chance for survival. The risk of conservative E .4In15 treatment often exceeds the risk of the operation. O- An aggressive approach to the diagnosis and treat- II II II ment of CHD is dictated by statistics. The estimated z a 10 5 incidence of CHD is 6-8/1000 live births. About 500o 963 99 6 of the children born with CHD die before their first 3 1 1 5 1 16 birthday unless effectively treated. The achievements in the treatment of CHD in infancy are the result of 1963~51964 1965 1966 1967 1968 1969 1970 1971 the combined efforts of paediatricians, cardiologists, FIG. 1. Open-heart surgery under I year of age at the copyright. surgeons, anaesthetists and nurses. Many other Great Ormond Street Thoracic Unit, February 1963 to specialists and technical staff contribute to the September 1971 (115 patients). Open columns, survived; diagnosis and treatment. closed columns, died. The experience of the Thoracic Unit, Hospital for Sick Children at Great Ormond Street, forms the Diagnosis basis of this report (unless otherwise stated).
    [Show full text]
  • Atrial Septal Stenting to Increase Interatrial Shunting in Cyanotic Congenital Heart Diseases: a Report of Two Cases
    422 Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(5):422-426 doi: 10.5543/tkda.2011.01368 Atrial septal stenting to increase interatrial shunting in cyanotic congenital heart diseases: a report of two cases Siyanotik doğuştan kalp hastalıklarında interatriyal şantı artırmak amacıyla atriyal septuma stent uygulaması: İki olgu sunumu Yalım Yalçın, M.D., Cenap Zeybek, M.D.,§ İbrahim Özgür Önsel, M.D.,# Mehmet Salih Bilal, M.D.† Departments of Pediatric Cardiology, #Anesthesiology and Reanimation, and †Cardiovascular Surgery, Medicana International Hospital; §Department of Pediatric Cardiology, Şişli Florence Nightingale Hospital, İstanbul Summary – Aiming to increase mixing at the atrial level, Özet – Siyanotik doğuştan kalp hastalığı tanısıyla izle- atrial septal stenting was performed in two pediatric nen iki bebekte, atriyal düzeyde karışımı artırmak ama- cases with cyanotic congenital cardiac diseases. The cıyla atriyal septuma stent yerleştirme işlemi uygulandı. first case was a 3-month-old male infant with transpo- Birinci olgu, büyük arterlerin transpozisyonu tanısıyla sition of the great arteries. The second case was an izlenen üç aylık bir erkek bebekti. Diğer olgu, ameliyat 18-month-old male infant with increased central venous sonrası dönemde sağ ventrikül çıkım yolu tıkanıklığına pressure due to postoperative right ventricular outflow bağlı olarak santral venöz basınç yüksekliği gelişen 18 tract obstruction. Premounted bare stents of 8 mm in aylık bir erkek bebekti. Her iki olguda da 8 mm çapında, diameter were used in both cases. The length of the balona monte edilmiş çıplak stent kullanıldı. Stent uzun- stent was 20 mm in the first case and 30 mm in the lat- luğu ilk olguda 20 mm, ikinci olguda 30 mm idi.
    [Show full text]
  • BAS Talk Linz
    Balloon atrial septostomy Dr Aphrodite Tzifa, MD(Res), FRCPCH! ! Director, Paediatric Cardiology Department, ! Mitera Children's Hospital, Athens, Greece September 10, 2003 ! BAS ! ! 1. The technique of atrial septostomy (BAS) was introduced in 1966 by Rashkind! ! 2. The interventional procedure is performed in neonates that are significantly cyanosed with preductal O2 saturations below 75% after birth or that need an atrial septal defect to offload the LA! “A technique for producing an atrial septal defect without thoracotomy or anesthesia is presented. It can be performed rapidly in any cardiac catheterization laboratory.” (William J. Rashkind, 1966) ! History ! ! “...The initial response to this report varied between admiration and horror but, in either case, the procedure stirred the imagination of the “invasive” cardiologists throughout the entire cardiology world and set the stage for all future intracardiac interventional procedures – the true beginning of pediatric and adult interventional cardiology.” (Charles E. Mullins, 1998) ! HOW to CREATE AN ASD? ! ! 1. Septostomy Balloons! 2. Low profile balloon (Tyshak)! 3. Static balloon (Powerflex, Opta)! 4. Cutting balloons! 5. Blade septostomy catheter! 6. Stenting! ! Transeptal puncture or RF perforation may occasionally be needed Need for creation or enlargement of an ASD: ! WHEN? ! ! 1. TGA: In some units, an atrial septostomy is performed routinely after birth, to ensure mixing of the blood at intracardiac level and discontinue the prostaglandin infusion. However, most would not advocate this due to the potential risk of complications in neonates that are otherwise stable. ! 2. Tricuspid or mitral atresia! 3. PA / IVS! 4. TAPVD with restrictive septum! 5. During hybrid procedures for HLHS syndrome! 6.
    [Show full text]
  • Balloon Atrial Septostomy in Complete Transposition of Great Arteries in Infancy
    Br Heart J: first published as 10.1136/hrt.32.1.61 on 1 January 1970. Downloaded from British HeartJournal, I970, 32, X6i. Balloon atrial septostomy in complete transposition of great arteries in infancy A. W. Venables From Royal Children's Hospital, Melbourne, Australia The results of 26 completed balloon atrial septostomies in complete arterial transposition in infancy are described, and complications discussed. Of 7 deaths following this procedure, 3 were clearly or probably related to it or to its failure to produce an adequate septal defect, while 4 were unrelated. Atrial perforations occurred on 4 occasions. Necropsy information regarding the defects produced by the procedure is given. Anatomical features of the fossa ovalis appear to determine the size of the defect created. The effect of the procedure is illustrated by photographs of representative necropsy specimens. Apparently adequate initial defects do not guarantee satisfactory long-term palliation, and 4 of iI infants followed for more than 6 months after effective initial palliation have required surgical procedures to provide more adequate atrial mixing of blood. Despite this, the procedure appears to offer considerable advantage over initial surgical procedures to create atrial defects. The value of palliative procedures in com- Subjects and methods plete arterial transposition is indisputable. From to mid-May I23 cases of trans- ig60 i969, http://heart.bmj.com/ Most commonly, atrial septal defects arz cre- position of the great arteries in infancy were diag- ated in order to increase effective pulmonary nosed in the Cardiac Unit of the Royal Children's flow. Since I966 the balloon catheter tech- Hospital, Melbourne.
    [Show full text]
  • ICD-9-CM Procedures (FY10)
    2 PREFACE This sixth edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for morbidity coding. The International Classification of Diseases, 9th Revision, published by the World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) programs. Guidance in the use of this classification can be found in the section "Guidance in the Use of ICD-9-CM." ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Centers for Medicare & Medicaid Services are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9- CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users.
    [Show full text]
  • Images Paediatr Cardiol
    W Boehm, M Emmel, and N Sreeram. Balloon Atrial Septostomy: History and Technique. Images Paediatr Cardiol. 2006 Jan-Mar; 8(1): 8–14. in PAEDIATRIC CARDIOLOGY IMAGES Images Paediatr Cardiol. 2006 Jan-Mar; 8(1): 8–14. PMCID: PMC3232558 Balloon Atrial Septostomy: History and Technique W Boehm, M Emmel, and N Sreeram University Hospital of Cologne, Germany. Contact information: N. Sreeram, Department of Paediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany Phone: +49 221 47886301 +49 221 47886301 Fax: +49 221 47886302 ; Email: [email protected] MeSH: Transposition of the great arteries, Heart defects, congenital, Catheter, invervention, Balloon atrial septostomy Copyright : © Images in Paediatric Cardiology This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction “A technique for producing an atrial septal defect without thoracotomy or anesthesia is presented. It can be performed rapidly in any cardiac catheterization laboratory.” (William J. Rashkind, 1966)1 “...The initial response to this report varied between admiration and horror but, in either case, the procedure stirred the imagination of the “invasive” cardiologists throughout the entire cardiology world and set the stage for all future intracardiac interventional procedures – the true beginning of pediatric and adult interventional cardiology.” (Charles E. Mullins, 1998)2 The natural history of untreated transposition of the great vessels in the neonate is poor. Complete correction has been possible since 1959 with the atrial switch procedure, first described by Senning.3 Mustard simplified this method, reducing mortality rates to a reasonable level.4 Best results with both operations were achieved in children beyond six months of age.
    [Show full text]
  • Left Atrial Decompression by Percutaneous Cannula Placement While on Extracorporeal Membrane Oxygenation
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Brief Communications provided by Elsevier - Publisher Connector Left atrial decompression by percutaneous cannula placement while on extracorporeal membrane oxygenation Anthony M. Hlavacek, MD, Andrew M. Atz, MD, Scott M. Bradley, MD, and Varsha M. Bandisode, MD, Charleston, SC enoarterial extracorporeal membrane oxygenation serially dilated with 10F and 16F transseptal sheath dilators. With (ECMO) is often used in pediatric patients with severe transesophageal echocardiography guidance, a 17F cannula was myocardial dysfunction, typically after cardiac sur- advanced over the guidewire into the LA and connected to the gery, or in patients with acute myocarditis. A problem venous ECMO circuit. Chest radiography confirmed resolution of Vfrequently encountered in these patients is left atrial hypertension, his pulmonary edema by the subsequent day. An echocardiogram which may result in pulmonary edema, ventricular distention, and revealed normalization of his LA size and an estimated LA pres- subendocardial ischemia.1,2 Decompression of the left atrium (LA) sure decrease to 18 mm Hg by Doppler measurement of the mitral will reduce diastolic pressures in the left heart, resulting in an regurgitation gradient. He remained on ECMO for 42 days until a improvement in coronary perfusion and lessen pulmonary edema. successful orthotopic heart transplant was performed. We describe the percutaneous placement of a venous cannula in the LA while on ECMO in a child with severe
    [Show full text]
  • Interventional Echocardiography: Opportunities and Challenges in an Emerging Field
    Henry Ford Health System Henry Ford Health System Scholarly Commons Cardiology Articles Cardiology/Cardiovascular Research 10-23-2020 Interventional echocardiography: Opportunities and challenges in an emerging field James Lee Tiffany Chen Edward Gill Follow this and additional works at: https://scholarlycommons.henryford.com/cardiology_articles Received: 1 June 2020 | Revised: 10 September 2020 | Accepted: 12 September 2020 DOI: 10.1111/echo.14874 REVIEW Interventional echocardiography: Opportunities and challenges in an emerging field James Lee MD1 | Tiffany Chen MD2 | Edward Gill MD3 1Division of Cardiology, Henry Ford Heart and Vascular Institute, Detroit, MI, USA Abstract 2Division of Cardiovascular Medicine, The growth of transcatheter structural heart disease interventions has created a Perelman School of Medicine, Hospital of subspecialty of interventional imagers who focus on preprocedural planning and the the University of Pennsylvania, Philadelphia, PA, USA periprocedural guidance of these complex cases. In particular interventional imag- 3Division of Cardiology, University of ers who focus on periprocedural guidance have developed a specific expertise in Colorado School of Medicine, Aurora, CO, USA interventional transesophageal echocardiography (iTEE). This nascent field has chal- lenges in training, reimbursement, and occupational hazards which are unique to this Correspondence James Lee, MD, Division of Cardiology, field. This review encompasses the evolution of iTEE, current challenges, and future Henry Ford Heart and Vascular
    [Show full text]
  • NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures
    NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures Measure Number: PCS‐001‐09 Measure Title: Participation in a national database for pediatric and congenital heart surgery Description: Participation in at least one multi‐center, standardized data collection and feedback program that provides benchmarking of the physician’s data relative to national and regional programs and uses process and outcome measures. Participation is defined as submission of all congenital and pediatric operations performed to the database. Numerator Statement: Whether or not there is participation in at least one multi‐center data collection and feedback program. Denominator Statement: N/A Level of Analysis: Group of clinicians, Facility, Integrated delivery system, health plan, community/population Data Source: Electronic Health/Medical Record, Electronic Clinical Database (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Clinical Registry (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Claims, Paper Medical Record Measure Developer: Society of Thoracic Surgeons Type of Endorsement: Recommended for Time‐Limited Endorsement (Steering Committee Vote, Yes‐9, No‐0, Abstain‐0) Attachments: “STS Attachment: STS Procedure Code Definitions” Meas# / Title/ Steering Committee Evaluation and Recommendation (Owner) PCS-001-09 Recommendation: Time-Limited Endorsement Yes-9; No-0; Abstain-0 Participatio n in a Final Measure Evaluation Ratings: I: Y-9; N-0 S: H-4; M-4; L-1 U: H-9; M-0; L-0 national F: H-7; M-2; L-0 database for Discussion: pediatric I: The Steering Committee agreed that this measure is important to measure and report. and By reporting through a database, it is possible to identify potential quality issues and congenital provide benchmarks.
    [Show full text]