Confirmed CCHD What next?

Transcription

1 Confirmed CCHD What next? Herbert J. Stern MD, FACC, FSCAI Children s Cardiology Associates and Dell Children s Hospital

2 Catheter Based Therapy: Spectrum of Procedures Tear PFO to enhance mixing (D-TGA) Dilate and/or stent narrowed valves (valvuloplasty) and vessels (angioplasty) Close abnormal vessels (PDA s, collaterals, etc) Close septal defects Open atretic valves, create fenestrations Implant transcatheter valves

3 Spectrum of Age Birth til

4 Balloon Septostomy

5 Valvuloplasty Mechanism of dilatation: commissural splitting Semilunar Valves most commonly(a-v valves rarely) Use oversize balloons for pulmonic valve Use % annulus size for aortic valve

6 Valvuloplasty-Critical PS

7 Valvuloplasty-Critical PS

8 RF Perforation of Pulmonary Atresia in 1500 gm Infant

9 Valvuloplasty-Critical AS

10 Valvuloplasty-Critical AS

11 Angioplasty Mechanism of dilatation: Does NOT stretch the vessel, but purposely tears the intima/media(hopefully not the adventitia) Vessel heals in open position Critical to properly size lesion to chose proper balloon size

12 Angioplasty-Coarctation of the Aorta

13 Endovascular Stents Wire mesh cylinders which must be handcrimped on balloon catheters or come premounted Indicated for vessel stenosis in: coarctation of the aorta, conduits, Mustard baffles, pulmonary arteries, etc.

14 Endovascular Stents

15 Coarctation of the Aorta

16 Endovascular Stents-RV to PA Conduits

17 Left Pulmonary Artery Stenosis

18 LPA stenosis

19 Poiseulle s Law (flow in rigid tubes)

20 Occlusion Devices

21

22 Gianturco Coil Occlusion

23 Amplatzer Ductal Occluder

24 Amplatzer Vascular Plug

25 Intralobar Pulmonary Sequestration

26 Coil Occlusion Aortopulmonary Collaterals (APCs)

27 Amplatzer Occlusion ASD

28 Balloon Sizing Both Defects

29 ASD Closure with two devices

30 TEE post delivery

31 Creating Fenestrations

32 Combination Lesions

33 Combination Lesions Usually occur in context of Single Ventricle Physiology Recoarctation of the Aorta (balloon and/or stent) SVC anastomosis or branch PA s (balloon and/or stent) Aortic and /or venous collaterals (vessel occlusion)

34 Angioplasty of Thrombosed LPA

35 Access to Vessel via Floppy- Tipped Wire

36 Stent of LPA and Coarcatation

37 Emerging Technologies

38 Transcatheter Valve Replacement (Bonhoeffer:Circ.2000;102:813-16) Bovine jugular vein containing native biological valve harvested, fixed and sterilized Sutured to interior of pre-expanded C-P stent Re-formed and crimped onto 18-22mm balloons

39 Bovine Valve Sutured in Stent Valved stent placed successfully in 7/11 lambs; 5/7 placed correctly across native pulmonary valve All 5 lambs with normal neo-pulmonic valve function after two months follow-up

40 Competent Valve Following Explantation Applications: Free PI with RV volume overload (e.g. TOF with transannular patch) RV-PA valved homograft deterioration (TOF/PA, Truncus, Ross procedure)

41 Transcatheter Valve Implantation

42

43 Hybrid Procedures

44 Thank You!