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Danyal Khan, M.D, FACC, FAAP, FSCAI Pediatric Interventional Cardiologist Miami Children's Hospital
Historical Perspective
Heart surgery-1940s Open heart surgery-1960s First therapeutic catheterization-1953 Last Decade
Advanced fetal diagnosis Explosion of interventional cath procedures Introduction of minimally invasive surgical techniques Near extinction of the inoperable patient Cardiac transplantation and immunosuppression
Surgery
Interventional Catheterization
Types of CHD
ACYANOTIC HEART DISEASE Pulse oximetry normal Left to Right Shunt Usually not symptomatic at birth CYANOTIC HEART DISEASE Pulse Oximetry may be low Right-to-Left Shunt Usually presents at young age
Adult CHD
Atrial Septal Defect (ASD) Patent Foramen Ovale (PFO) Coarctation Pulmonary Regurgitation
Diagram
AORTA
Case - ASD
52 year old lady with c/o SOB & Palpitations EKG incomplete RBBB CXR Cardiomegaly Echo- Severe Pulm HTN, Marked RA & RV dilation, Severe TR O/E- Sats 94%, decreased to 84% with exertion Fixed split & loud S2, Flow Murmur Early clubbing & cyanosis
Cardiac MRI
Pulmonary artery dilation
Heterotaxy
No IVC
Management
Diagnostic Cath Treated with Oxygen via nasal cannula & Revatio (sildenafil) After 3 months repeat cath
Cardiac Cath
IVC
RA IVC
IntraCardiac Echo
Hepatic Access
ICE Catheter
Wire
ASD - Echo
ASD Device
Left Disc
Right Disc
Device released
PFO
In Fetal circulation, presence of a PFO is essential PFO usually closes within the first two weeks of life Persistant PFO is present in more than 25% of adults
Causes of Death
Cryptogen
43%
POSITIVE RESULTS
NEGATIVE RESULTS
M as 20
10 20 30 0
La us a nn e (1 9 96 )
1.90 0.60
M as 20 D 01 :
5.4
01 : (P FO
MEDICAL THERAPY
REGISTRY DATA
% Adjusted 1 Yr Stroke-TIA
5.55 4.86
5.2
4
2.71
2.95
2
1.3
Surgery
Medical therapy
Device
Amplatzer
HELEX
Case # 1
14 year old girl, who was in a car accident and suffered a left tibial fracture Patient was neurologically normal after the accident 36 hours later had a stroke TTE PFO. Bubble study positive Confirmed with transcranial doppler PFO closed with Sideris Button device
Case # 2 (AS)
17 year old girl with c/o palpitations and has had two episodes of TIA (right sided hemiparesis + dysarthria) Holter non sustained wide QRS tachycardia EPStudy no inducible Vent Tachycardia TTE Bubble study positive Hypercoagulability w-up: negative
Helex
Balloon Sizing
Balloon Sizing
Helex implanted
Helex released
Case # 3 (CA)
55 yr old gentleman. h/o two episodes of TIA Carotid u/s normal Hypercoag w-up Negative No HTN or HyperLipidemia TTE: Atrial Septal Aneurysm + PFO (positive bubble study)
PFO
CardioSeal snared
Final Result
Coarctation of Aorta
8-10% of Congenital Heart Disease Male:Female ratio = 2:1 Turners syndrome 30% incidence 85% incidence of Bicuspid Aortic Valve Most patients present in infancy & childhood
Coarctation in Adults
Presentation
Hypertension resistant to therapy CXR rib notching due to collaterals
Diagnosis
BP difference between arm & leg Echo MRI/CT
Case - Coarctation
21 year old with h/o Coarctaton Repaired in infancy c/o Hypertension 140/90 Echo coarctation with 30 mm Hg gradient
Cath Angiogram
Cath Angiogram
Cath Angiogram
Cath Angiogram
Cath Angiograms
Cath Angiograms
Cath Angiograms
Cath Angiograms
Aneurysm
Covered Stent
Final Result
Case
22 year old lady, h/o Tetralogy of Fallot
VSD closure + RV to PA homograft
Has had Aortic Valve replacement 23mm St Jude Valve c/o decreased exercise tolerance Echo
Severe pulmonary regurgitation Right ventricular dilation & dysfunction
Traditional Rx
Surgical valve placement
The Solution
RV
Melody Valve
Cath Angiograms
Cath Angiograms
Sizing
Cath Angiograms
Balloon Angioplasty
Stent
Melody Valve
No Pulmonary Regurgitation
Thank you