Diabolo Stent - Fontan Fenestration Creation, Creation of Dumbell shape

Catheter Cardiovasc Interv. 2010 Nov 15;76(6):860-4.
Novel technique to reduce the size of a Fontan Diabolo stent fenestration.
Anderson B, Bhole V, Desai T, Mehta C, Stumper O.
Source
The Birmingham Children's Hospital, Birmingham, United Kingdom.

Abstract
OBJECTIVES:
To develop an effective catheter technique to reduce the size of a Diabolo stent fenestration in the failing Fontan circulation.

BACKGROUND:
Diabolo stent fenestration is employed by many centers in the treatment of the failing Fontan patient. With subsequent recovery, exercise tolerance may be impaired by significant desaturation secondary to the right to left shunt across the fenestration. Complete fenestration closure carries the risk of recurrence of the initial symptoms and, hence, reduction of the size of fenestration should be the preferred technique.

METHODS:
Twenty-eight patients with failing Fontan circulations (16 early and 12 late) underwent Diabolo stent fenestration for relief of symptoms. Five of these patients remained very limited by severe desaturation even at rest, after complete recovery from symptoms. Further cardiac catheterization with crimping/reduction of the size of the waist of the stent was carried out using a technique whereby a snare catheter was placed over the waist of the stent aided by an arterio-venous guidewire loop and a balloon catheter placed within the stent.

RESULTS:
All 5 patients had successful stent reduction with improvement in saturations, whilst still maintaining a small residual fenestration. No complications were encountered.

ONCLUSION:
This novel technique of reduction of a diabolo stent fenestration, in a failing Fontan circulation, offers the advantages of avoidance of implanting further devices in the circulation and the ability to redilate the stent should symptoms recur.

Copyright © 2010 Wiley-Liss, Inc.

Bifurcation stenting - RVOT. Branch PA, Coarctation

Catheter Cardiovasc Interv. 2011 Sep 1;78(3):419-24. doi: 10.1002/ccd.23025. Epub 2011 Mar 30.
A novel technique for stenting pulmonary artery and conduit bifurcation stenosis.
Stumper O, Bhole V, Anderson B, Reinhardt Z, Noonan P, Mehta C.
SourceHeart Unit, Birmingham Children's Hospital, United Kingdom. oliver.stumper@bch.nhs.uk

Abstract
BACKGROUND: Distal conduit obstruction is a recognized complication after surgery for congenital heart disease requiring implantation of a conduit from the right ventricle to the pulmonary arteries. Endovascular stenting of distal conduit obstruction can be challenging due to the proximity to the pulmonary artery bifurcation.

OBJECTIVE: A technique is described, whereby a single stent is mounted onto two balloon angioplasty catheters in tandem. This ensemble was delivered to the distal conduit/pulmonary artery via a large Mullins sheath on two guidewires, one placed in each of the branch pulmonary arteries. The aim was to assess safety and efficacy of this novel technique.

MATERIALS AND RESULTS: Seven patients (mean age 13.4 (6.7-23.4) years, mean weight 44.2 (23-69) kg were treated with this method. The pressure gradient was reduced from 36 (26-52) mm Hg to 11 (8-15) mm Hg [P< 0.05]. RV/LV pressure ratio decreased from 0.85 (0.6-0.95) to 0.42 (0.35-0.5) [P < 0.05]. There were no significant complications. During follow-up over a median of 2.6 (0.3-6.7) years no patient required re-intervention or surgery.

CONCLUSION: This novel technique appears to be safe and effective for stenting stenoses just proximal to pulmonary artery bifurcation.

Copyright © 2011 Wiley-Liss, Inc.



Catheter Cardiovasc Interv. 2011 Sep 1;78(3):425-7.



Dual wire technique for aortic coarctation stent placement.
Lampropoulos K, Budts W, Gewillig M.
SourceCongenital, University Hospitals Leuven, Belgium.

Abstract
A young adult presented for percutaneous treatment of a narrow aortic coarctation. A very large left subclavian artery originated immediately proximal to the coarctation. In order not to exclude or jail the left subclavian artery with a stent, a double wire technique was used. From a femoral approach, two guide wires were positioned, one in the aortic arch and another in the subclavian artery. A stent crimped over a 16-mm balloon and a 4-Fr catheter was advanced over the two wires within a 14-Fr long introducer sheath. The stent was successfully deployed and molded within the bifurcation by a kissing balloon technique, relieving the obstruction and leaving a guaranteed passage to the subclavian artery. The double wire technique is an elegant way to deliver a stent safely across a narrowing with guaranteed access to important side branches.

Copyright © 2010 Wiley-Liss, Inc.

Figure-8 stitch - For Hemostasis of femoral vein access

Catheter Cardiovasc Interv. 2011 Jul 1;78(1):155-60.

Technique of temporary subcutaneous "Figure-of-Eight" sutures to achieve hemostasis after removal of large-caliber femoral venous sheaths.

Cilingiroglu M, Salinger M, Zhao D, Feldman T.
SourceNorthShore University HealthSystem, Evanston, Illinois, USA.

Abstract
Over the last decade, significant advances have been made in percutaneous treatment of structural heart diseases. Many of these interventions require insertion of large caliber sheaths in the femoral veins. Manual compression, compression devices, and various closure devices have been used for removal of large-sized venous sheaths. Here, we describe the use of a temporary subcutaneous "Figure-of-Eight" suture technique for venous access site closure after removal of large-caliber sheaths.

Copyright © 2011 Wiley-Liss, Inc.