Balloon Pulmonary Valvuloplasty - Safety & Efficacy

Catheter Cardiovasc Interv. 2012 Oct 1;80(4):663-72.

Safety and efficacy of balloon pulmonary valvuloplasty: A Multicenter Experience.

Holzer RJ, Gauvreau K, Kreutzer J, Trucco SM, Torres A, Shahanavaz S, Bergersen L.

METHODS: Prospective data collection. C3PO Registry. Cases performed between 02/07 and 06/10 at eight institutions. The registry was queried for cases of isolated BPV.


RESULTS:
211 cases were included (45%, Less than 1 month old).

Procedural success was achieved in 91% procedures, being defined as one of the following:
   (i) post-BPV peak systolic valvar gradient to < 25 mm Hg (88%),
   (ii) decrease in gradient by 50% (79%), or
   (iii) reduction of RV/systemic pressure ratio by 50% (45%).

Procedural success was more common in neonates, when compared to older patients (96% vs. 87%, P = 0.03).

Procedure failure - Risk factors included (i) moderate or severe pulmonary valve thickening (OR 2.9, CI 1-8.3), and (ii) presence of supravalve PS (OR 9.6, CI 2.7-33.8).

Adverse events:
Low severity AEs (levels 1-2) occurred in 9% of patients.
Higher severity AEs (levels 3-5) occurred in 3% of patient.
No deaths.
Risk factors for any AE (levels 1-5) were (i) age below 1 month (OR 3.5, CI 1.3-8.9) and (ii) operator experience of less than 10 years (OR 3.8, CI 1.5-9.9).

CONCLUSIONS: Procedural success is common and AEs, especially higher severity AEs, are rare for BPV in patients with isolated PS. Results have improved considerably when compared to historical data.

© 2012 Wiley Periodicals Inc.

Zoll LifeVest

From http://www.lifevest.zoll.com/medical-professionals/lifevest-overview.asp

Articles on Single Ventricle Reconstruction Surgery from October 2012 issue of JTCVS

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Congenital Heart Disease

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Introduction to the Single Ventricle Reconstruction trial

Emile Bacha and Pedro del Nido

J Thorac Cardiovasc Surg 2012;144 880-881

http://jtcs.ctsnetjournals.org/cgi/content/extract/144/4/880?etoc





Risk factors for hospital morbidity and mortality after the Norwood

procedure: A report from the Pediatric Heart Network Single Ventricle

Reconstruction trial

Sarah Tabbutt, Nancy Ghanayem, Chitra Ravishankar, Lynn A. Sleeper, David

S. Cooper, Deborah U. Frank, Minmin Lu, Christian Pizarro, Peter Frommelt,

Caren S. Goldberg, Eric M. Graham, Catherine Dent Krawczeski, Wyman W. Lai,

Alan Lewis, Joel A. Kirsh, Lynn Mahony, Richard G. Ohye, Janet Simsic,

Andrew J. Lodge, Ellen Spurrier, Mario Stylianou, Peter Laussen Pediatric

Heart Network Investigators

J Thorac Cardiovasc Surg 2012;144 882-895

http://jtcs.ctsnetjournals.org/cgi/content/abstract/144/4/882?etoc





Interstage mortality after the Norwood procedure: Results of the

multicenter Single Ventricle Reconstruction trial

Nancy S. Ghanayem, Kerstin R. Allen, Sarah Tabbutt, Andrew M. Atz, Martha

L. Clabby, David S. Cooper, Pirooz Eghtesady, Peter C. Frommelt, Peter J.

Gruber, Kevin D. Hill, Jonathan R. Kaltman, Peter C. Laussen, Alan B.

Lewis, Karen J. Lurito, L. LuAnn Minich, Richard G. Ohye, Julie V.

Schonbeck, Steven M. Schwartz, Rakesh K. Singh, Caren S. Goldberg

Pediatric Heart Network Investigators

J Thorac Cardiovasc Surg 2012;144 896-906

http://jtcs.ctsnetjournals.org/cgi/content/abstract/144/4/896?etoc





Cause, timing, and location of death in the Single Ventricle Reconstruction

trial

Richard G. Ohye, Julie V. Schonbeck, Pirooz Eghtesady, Peter C. Laussen,

Christian Pizarro, Peter Shrader, Deborah U. Frank, Eric M. Graham, Kevin

D. Hill, Jeffrey P. Jacobs, Kirk R. Kanter, Joel A. Kirsh, Linda M.

Lambert, Alan B. Lewis, Chitra Ravishankar, James S. Tweddell, Ismee A.

Williams, Gail D. Pearson Pediatric Heart Network Investigators

J Thorac Cardiovasc Surg 2012;144 907-914

http://jtcs.ctsnetjournals.org/cgi/content/abstract/144/4/907?etoc





Variation in perioperative care across centers for infants undergoing the

Norwood procedure

Sara K. Pasquali, Richard G. Ohye, Minmin Lu, Jonathan Kaltman, Christopher

A. Caldarone, Christian Pizarro, Carolyn Dunbar-Masterson, J. William

Gaynor, Jeffrey P. Jacobs, Aditya K. Kaza, Jane Newburger, John F. Rhodes,

Mark Scheurer, Eric Silver, Lynn A. Sleeper, Sarah Tabbutt, James Tweddell,

Karen Uzark, Winfield Wells, William T. Mahle, Gail D. Pearson Pediatric

Heart Network Investigators

J Thorac Cardiovasc Surg 2012;144 915-921

http://jtcs.ctsnetjournals.org/cgi/content/abstract/144/4/915?etoc

Guidelines: Cardiovascular Risk Reduction in Children

Link to free full text (Pediatrics 2011;128(Suppl 5):S213-S256).

Extensive data on evidence of risk and comprehensive review of current treatment options for children.

Epidemiology: Prevalence of CHD in US

Prevalence of CHD in US

Poster presented at ACC 2012: (JACC 2012;59(Supplement 1):E787.

These numbers were derived by extrapolating data from Quebec population study (Circ 2007;115:163-72) & 2010 US Census data.

(Click on the image to enlarge)

Prevalence of CHD in Europe

(Circulation 2011;123:841-9)

Prevalence in Quebec

(Circulation 2007;115:163-72)

Scoring system to determine need for LA decompression

J Heart Lung Transplant. 2003 Aug;22(8):883-8.


Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants with hypoplastic left heart syndrome.

Mulla NF, Osher AP, Beeson WL, Kuhn MA, Larsen RL.

SourceDepartment of Pediatrics, Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California 92534 , USA. nmulla@ahs.llumc.edu



Abstract

BACKGROUND: Restrictive interatrial communication (IAC) causes morbidity and mortality in infants with hypoplastic left heart syndrome awaiting cardiac transplantation. We sought to create a scoring system, based on echocardiographic and clinical findings, to serve as a guide for determining the need for balloon atrial septostomy (BAS).



METHODS: We retrospectively reviewed echocardiograms of 44 infants with hypoplastic left heart syndrome. Infants were studied from the time of admission to the final end-point of transplantation, Norwood procedure, or death. Seventeen infants underwent BAS for clinical indications of oxygen saturation <80% in room air. Data collected included age at BAS, maximum velocity (V(max)), and IAC diameter throughout the clinical course. We assigned higher IAC scores to smaller IAC diameter, greater V(max) through the IAC, and lower oxygen saturation value. The minimum score was 3, and the maximum score was 9.



RESULTS: Only 10% of infants with a score <6 at presentation required BAS, whereas 67% of those with scores > or =6 required BAS. Higher IAC scores at presentation were associated with earlier need for BAS (p = 0.04).



CONCLUSIONS: The IAC scoring system can serve as a reliable clinical guide for identifying infants with hypoplastic left heart syndrome who are likely to require BAS for relief of critically restrictive IAC while awaiting cardiac transplantation.

Endocarditis Prophylaxis 2007 Guidelines are right.

New study published online Circulation 2012 supports 2007 guidelines.
Be sure to check the editorial associated with this article.

This article is reviewed in theheart.org "heartwire" as well.