Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children:Experience from a Single Center

Background:Limited data are available regarding intermediate and long-term outcomes of transcatheter closure(TCC)of coronary cameral fistulas(CCFs)in the pediatric patients.Methods:All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study.Results:A total of 66 patients(median age:3.93 years,median weight:15 kg)underwent attempted TCC of CCFs.Immediate successful device implantation was achieved in 62 patients,and immediate complete occlusion was achieved in 44 patients(44/62%,71.0%).The closure procedure was waived in 2 patients due to anatomical factors.A total of 6 periprocedural complications occurred in 5 patients,including acute myocardial infarction(n=3),procedure-related death(n=1),device embolization(n=1),and rupture of tricuspid chordae tendineae(n=1).The acute procedural success rate was 89.4%(59/66),while the acute complication rate was 9.1%(6/66).Follow-up data were collected for 58(93.5%)out of 62 patients at a median of 9.3 years(range:3.0–15.7 years).10 adverse events occurred in 9 patients,including 5 follow-up complications(1 aortic valve perforation,1 coronary thrombosis,1 progressive aneurysmal dilation after reintervention,and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation),and 5 closure failure with large residual shunts.The intermediate and long-term adverse event rate was 17.2%(10/58).The anatomical features associated with both acute and follow-up adverse events were large CCFs(p=0.005),and giant coronary artery aneurysms(CAAs)(p=0.029).Conclusions:TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate.Large CCFs and giant CAAs represent a higher risk of both acute and intermediate and long-term adverse events after closure.

Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolapse

Objective:This study aims to evaluate the morphology and function of the aortic valve after transcatheter closure of ventricular septal defect(VSD)with aortic valve prolapse(AVP)abased on clinical and radiological outcomes.Methods:From January 2013 to November 2014,164 consecutive patients(97 males,59.1%)with VSD and AVP were treated by transcatheter closure.The patients were divided into the mild AVP group(n=63),moderate AVP group(n=89)and severe AVP group(n=12).The clinical and radiological outcomes of these patients were analyzed retrospectively.Results:In total,146(89.0%)patients were successfully treated with VSD occluders,including 59/63(93.7%)with mild AVP,80/89(89.9%)with moderate AVP and 7/12(58.3%)with severe AVP.The degree of AVP was ameliorated or disappeared in 39(26.7%)patients,and remained unchanged in 103(70.5%)patients after the intervention.In the 35 patients who initially had trivial-to-moderate aortic regurgitation(AR),the degree of AR was ameliorated or disappeared in 25(71.4%)patients,aggravated from trivial to mild AR in 1(2.9%)patient,and remained unchanged in 9(25.7%)patients.In 111 patients without AR,1(0.9%)patient had mild AR and 24(21.6%)patients had trivial AR after intervention.The depth and width of the prolapsed aortic valve decreased after transcatheter closure of VSD in all three groups.During the 70-month(range,54–77)follow-up period,no patients with AVP and AR needed an aortic valve intervention.Conclusions:Transcatheter closure of VSD with AVP is feasible.The morphology and function of the prolapsed aortic valve improved and remained stable for a long period after intervention.

Optical coherence tomography of the pulmonary arteries in children with congenital heart diseases:A systematic review

Importance:Optical coherence tomography(OCT)is a high-resolution intravascular imaging tool and has shown promise for providing real-time quantitative and qualitative descriptions of pulmonary vascular structures in vivo in adult pulmonary hypertension(PH),while not popular in pediatric patients with congenital heart diseases(CHD).Objective:The aim of this review is to summarize all the available evidence on the use of OCT for imaging pulmonary vascular remodeling in pediatric patients.Methods:We conducted the systematic literature resources(Cochran Library database,Medline via PubMed,EMBASE,and Web of Knowledge)from January 2010 to December 2021 and the search terms were“PH”,“child”,“children”,“pediatric”,“OCT”,“CHD”,“pulmonary vessels”,“pulmonary artery wall”.Studies in which OCT was used to image the pulmonary vessels in pediatric patients with CHD were considered for inclusion.Results:Five studies met the inclusion criteria.These five papers discussed the study of OCT in the pulmonary vasculature of different types of CHD,including common simple CHD,complex cyanotic CHD,and Williams-Beuren syndrome.In biventricular anatomy,pulmonary vascular remodeling was primarily reflected by pulmonary intima thickening from two-dimensional OCT.In single-ventricle anatomy,due to the state of hypoxia,the morphology of pulmonary vessels was indirectly reflected by the number and shape of nourishing vessels from three-dimensional OCT.Interpretation:OCT may be an adequate imaging procedure for the demonstration of pulmonary vascular structures and provide additional information in pediatric patients.