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Cardiology
Pediatric and Adult Congenital Cardiac Interventions
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
11 sections · 128 slides
Overview
- Scope of transcatheter congenital intervention
General principles and equipment
- Sedation and anaesthesia in the catheterisation laboratory
- Echocardiographic guidance: TEE and ICE
- Fluoroscopy and advanced cross-sectional imaging
- Laboratory and personnel requirements
- The adult congenital heart disease population
- Working relationship of the congenital heart team
Congenital pulmonary stenosis
- Isolated valvular pulmonary stenosis
- Clinical presentation of severe pulmonary stenosis
- Indications for balloon pulmonary valvuloplasty
- Outcomes of balloon pulmonary valvuloplasty
- Critical pulmonary stenosis and membranous pulmonary atresia
- Vascular access and haemodynamics before valvuloplasty
- Balloon selection and inflation technique
- Management of a suboptimal valvuloplasty result
- Sequence of balloon pulmonary valvuloplasty
- Indications for RVOT and ductal stenting
- RVOT stenting technique
- Comparison of palliation strategies for ductal-dependent flow
- Ductal stenting: access and anatomy
- Ductal stenting for pulmonary blood flow
Pulmonary artery stenosis
- Pulmonary artery stenosis: frequency and associations
- Distribution and clinical features of pulmonary artery stenosis
- Choosing between catheter and surgical therapy
- Percutaneous modalities for pulmonary artery stenosis
- Access and lesion assessment in pulmonary artery intervention
- Balloon sizing for pulmonary artery angioplasty
- Criteria for successful pulmonary artery dilation
- Cutting balloon technique and its limitations
- Considerations before stenting a pulmonary artery
- Indications for hybrid intraoperative stent placement
- Branch pulmonary artery stenting in a Fontan circuit
Congenital valvular aortic stenosis
- Morphology of congenital aortic stenosis
- Mechanism of myocardial ischaemia in severe aortic stenosis
- Clinical presentation across age groups
- Goals of balloon aortic valvuloplasty
- Balloon sizing in aortic valvuloplasty
- Haemodynamic assessment before aortic valvuloplasty
- Gradient thresholds for intervention in aortic stenosis
- Crossing the aortic valve and stabilising the balloon
- Balloon aortic valvuloplasty in an adolescent
Coarctation of the aorta
- Coarctation of the aorta: frequency and associations
- Presentation of coarctation from neonate to adult
- Indications for coarctation intervention
- Access routes and baseline aortography
- When balloon angioplasty is used for coarctation
- Balloon inflation and post-dilation assessment
- Recognising aortic injury during coarctation intervention
- Stent angioplasty for coarctation
- Stent treatment of aortic coarctation
Patent ductus arteriosus closure
- Haemodynamic consequences of a patent ductus arteriosus
- Natural history of the unrepaired duct
- The duct in the adult congenital patient
- Technique of transcatheter ductal closure
- Information required from the ductal angiogram
- Ductal closure in the premature and low-birth-weight infant
- Assessment of device position and residual shunt
- Post-procedure care after ductal device closure
- Adverse events after ductal device closure
- Device closure of a patent ductus arteriosus
Percutaneous ventricular septal defect closure
- Types and frequency of ventricular septal defect
- Natural history and surgical results in VSD
- Devices and patient selection for percutaneous VSD closure
- Indications for a hybrid perventricular approach
- Access and baseline study for VSD device closure
- Transoesophageal assessment before device deployment
- Device sizing for ventricular septal defect closure
- Creating the arteriovenous rail across the defect
- Establishing the delivery track for VSD closure
- Device deployment and confirmation
- Device behaviour on release and residual defects
- Antibiotic policy after VSD device closure
- Transcatheter closure of perimembranous defects
- Device closure of a perimembranous ventricular septal defect
Coronary artery fistula
- Anatomy and distribution of coronary artery fistula
- Presentation and complications of coronary artery fistula
- Assessment before fistula closure
- Principles of transcatheter fistula occlusion
- Access and the coaxial system for fistula closure
- Balloon test occlusion before closure
- Choice of occlusion device and delivery route
- Outcomes and antithrombotic strategy after fistula closure
Single-ventricle anatomy and physiology
- Lesions leading to single-ventricle palliation
- Stages of single-ventricle palliation
- Physiology of the Fontan circulation
- External conduit Fontan circuit with surgical fenestration
- Sites of Glenn and Fontan circuit obstruction
- Interpreting haemodynamics in the Fontan circuit
- Causes of hypoxaemia in lateral tunnel Fontan patients
- Covered stent exclusion of a fenestrated lateral tunnel
- Covered stent revision of a fenestrated lateral tunnel Fontan
- Transcatheter creation of a Fontan fenestration
- Technique for creating a Fontan fenestration
- Fenestration: closure versus creation
- Aortopulmonary collateral vessels in single-ventricle patients
- Safety checks before collateral embolisation
- Embolisation agents for aortopulmonary collaterals
- Coil occlusion of internal mammary collateral networks
- Venovenous collaterals after Glenn or Fontan
- Angiographic search for venovenous collaterals
- Deciding whether to close a venovenous collateral
- Plug closure of an innominate vein collateral
- Pulmonary arteriovenous malformation: mechanism
- Presentation of pulmonary arteriovenous malformation
- Treatment of pulmonary arteriovenous malformation
- Microscopic malformations after Glenn are not embolisable
Summary
- Lesion-specific balloon sizing rules
- Recurring themes across congenital interventions
- Limits of current congenital interventional practice
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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