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Cardiology
Cardiac Catheterization for the Adult with Complex Congenital Heart Disease
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 151 slides
Introduction and pre-catheterization workup
- Scope of adult congenital heart disease
- Operator and centre requirements
- Sedation and vascular access
- Ventilation conditions for baseline haemodynamics
- Anticoagulation and antibiotic prophylaxis
Haemodynamic assessment
- Role of oximetry in the congenital study
- Oxygen content calculation
- Oxygen step-up thresholds for left-to-right shunt
- Flow calculations and Flamm's formula
- From saturations to shunt flow
- Classification of shunts
- Bidirectional shunts and pacing lead thrombus risk
- Atrial pressure waveforms
- Ventricular and arterial pressure findings
- Angiographic targets in the congenital study
- Ventriculography and pulmonary angiography technique
- Pulmonary wedge angiography and biplane imaging
Anomalous coronary arteries and coronary fistulae
- Spectrum of coronary anomalies
- Anomalous origin of the left circumflex artery
- Anomalous left coronary artery from the pulmonary artery
- Pathophysiology of ALCAPA
- Presentation of ALCAPA
- Angiographic technique in ALCAPA
- Management principle for coronary anomalies
- Suggested inventory: anomalous coronary artery study
- Coronary fistulae: anatomy and drainage
- Coronary fistula from the left anterior descending artery
- Clinical consequences of a coronary fistula
- Management of coronary fistulae
- Suggested inventory: coronary fistula assessment
- Myocardial bridging
- Myocardial bridging of the left anterior descending artery
- Assessment of a significant myocardial bridge
Coarctation of the aorta and patent ductus arteriosus
- Coarctation of the aorta: epidemiology and site
- Natural history and associated arteriopathy
- Late outcomes after coarctation repair
- Collateral circulation in adult coarctation
- Coarctation of the aorta on CT and invasive aortography
- Imaging and gradient measurement in coarctation
- Indications that lower the gradient threshold
- Catheterization protocol for coarctation
- Measurement aids and treatment of coarctation
- Suggested inventory: coarctation catheterization
- Patent ductus arteriosus: presentation
- Small and restrictive ducts
- Route of PDA closure and its contraindication
- Shunt run and angiography in patent ductus arteriosus
- Patent ductus arteriosus on descending aortography
- Suggested inventory: patent ductus arteriosus
Tetralogy of Fallot and right heart outflow lesions
- Tetralogy of Fallot: definition
- Components of early tetralogy repair
- Catheterization goals after tetralogy repair
- Angiography after tetralogy repair
- Coronary assessment before reintervention
- Pulmonary regurgitation and valve replacement
- RVOT obstruction: haemodynamic and angiographic findings
- Grading of pulmonary stenosis by peak gradient
- Branch pulmonary artery stenosis
- Assessing significance of branch pulmonary artery stenosis
- Suggested inventory: branch pulmonary artery work
- Wires and balloons for branch pulmonary artery work
Sinus of Valsalva aneurysm
- Sinus of Valsalva aneurysm: definition and distribution
- Congenital versus acquired aneurysms
- Rupture of a sinus of Valsalva aneurysm
- Sinus of Valsalva aneurysm rupture into the right ventricular outflow tract
- Imaging and the role of catheterization in SVA
- Treatment options for sinus of Valsalva aneurysm
- Antegrade transcatheter SVA closure: setting up
- Creating the arteriovenous loop
- Device delivery and release in SVA closure
- Closing the sinus of Valsalva case
- Suggested inventory: sinus of Valsalva closure
Transposition of the great arteries
- Dextro-transposition of the great arteries
- Surgical approaches to dextro-transposition
- Adult problems after arterial switch
- Adult problems after atrial switch
- Catheterization of the failing systemic right ventricle
- Superior baffle angiography
- Inferior baffle leak on angiography
- Navigating to the pulmonary artery after atrial switch
- Bent wire and pulmonary artery catheter path
- Suggested inventory: transposition catheterization
- Devices for systemic baffle leak closure
- Access and imaging for baffle leak closure
- Baseline study before baffle leak closure
- Crossing and sizing the baffle leak
- Balloon sizing of an inferior baffle leak
- Deploying and releasing the closure device
- Baffle leak closure with an Amplatzer device
- Final angiographic views after baffle leak closure
- Suggested inventory: baffle leak closure
- Suggested inventory: systemic baffle stenting
- Access for systemic baffle stenting
- Baffle stenting: crossing and dilating
- Stent deployment and haemostasis
- Recanalization and stenting of an obstructed superior Mustard limb
- Stent positioning and pacing leads
- Pulmonary venous baffle obstruction
- Transbaffle approach to pulmonary venous baffle stenting
- Transseptal puncture and sheath positioning
- Crossing and stenting the pulmonary venous baffle
- Managing the septostomy at the end of the case
- Pulmonary venous baffle stenting
- Suggested inventory: pulmonary venous baffle stenting
- Congenitally corrected transposition of the great arteries
- Catheterization indications in cc-TGA
- Suggested inventory: cc-TGA catheterization
- Transcatheter edge-to-edge repair in congenital heart disease
- Platform choice for the systemic AV valve
- Edge-to-edge repair of the systemic atrioventricular valve in cc-TGA
- Platform choice for the subpulmonic AV valve
- Edge-to-edge repair of a common atrioventricular valve
- Ebstein's anomaly
Single ventricle physiology and the Fontan circulation
- Staged palliation to the Fontan circulation
- Fontan physiology and its pressure requirement
- Long-term complications of the Fontan circulation
- Sites of Fontan pathway obstruction
- Named sites of Fontan pathway obstruction
- Left innominate vein narrowing
- Pressure assessment across the Fontan pathway
- Consequences of venovenous fistulae in Fontan patients
- Standard Fontan angiograms
- Fontan and Glenn segment angiography
- Indications for venovenous collateral closure
- Suggested inventory: Fontan catheterization
- Major aortopulmonary collateral arteries
- Management of aortopulmonary collaterals
- Angiographic protocol for aortopulmonary collaterals
- Aortography and selective MAPCA angiography
- Suggested inventory: aortopulmonary collateral study
- Interrupted inferior vena cava
- Interrupted inferior vena cava with azygos continuation
Pulmonary hypertension and special issues
- Pulmonary vascular disease in congenital heart disease
- Pulmonary hypertension in specific ACHD settings
- Eisenmenger syndrome
- Sedation and contrast in the cyanotic patient
- Organisation of adult congenital cardiac care
- References
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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