Since publication of the last American Heart Association (AHA) scientific statement on this topic in 1998,1 device technology, advances in interventional techniques, and an innovative spirit have opened the field of congenital heart therapeutic catheterization. Unfortunately, studies testing the safety and efficacy of catheterization and transcatheter therapy are rare in the field because of the difficulty in identifying a control population, the relatively small number of pediatric patients with congenital heart disease (CHD), and the broad spectrum of clinical expression. This has resulted in the almost exclusive “off-label” use of transcatheter devices, initially developed for management of adult diseases, for the treatment of CHD.

The objective of the present writing group, which included representatives of the AHA and endorsements from the Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics, was not only to provide the reader with an inventory of diagnostic catheterization and interventional treatment options but also to critically review the literature and formulate relative recommendations that are based on key opinion leader expertise and level of evidence. The writing group was charged with the task of performing an assessment of the evidence and giving a classification of recommendations and a level of evidence to each recommendation. The American College of Cardiology/AHA classification system was used, as follows:

### Classification of Recommendations

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease A Scientific Statement From the American Heart Association

Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts; P =0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts; P P =0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8–91.1; P P P P =0.006), and larger (152 mm 2 /m 2 [95% CI, 132–176] versus 125 mm 2 /m 2 [95% CI, 113–138]; P =0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8–0.89] versus 0.77 [95% CI, 0.75–0.8]; P =0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.

Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative

CONTEXT: Patent ductus arteriosus (PDA) is a precursor to morbidity and mortality. Percutaneous (catheter-based) closure is the procedure of choice for adults and older children with a PDA, but use during infancy ( OBJECTIVE: Investigate the technical success and safety of percutaneous PDA closure during infancy. DATA SOURCES: Scopus, Web of Science, Embase, PubMed, and Ovid (Medline) were searched through December 2015 with no language restrictions. STUDY SELECTION: Publications needed to clearly define the intervention as percutaneous PDA closure during infancy ( DATA EXTRACTION: The study was performed according to the Systematic Reviews and Meta-Analysis checklist and registered prospectively. The quality of the selected studies was critically examined. Data extraction and assignment of AE attributability and severity were independently performed by multiple observers. Outcomes were agreed on a priori. Data were pooled by using a random-effects model. RESULTS: Thirty-eight studies were included; no randomized controlled trials were found. Technical success of percutaneous PDA closure was 92.2% (95% confidence interval [CI] 88.8–95.0). Overall AE and clinically significant AE incidence was 23.3% (95% CI 16.5–30.8) and 10.1% (95% CI 7.8–12.5), respectively. Significant heterogeneity and publication bias were observed. LIMITATIONS: Limitations include lack of comparative studies, lack of standardized AE reporting strategy, and significant heterogeneity in reporting. CONCLUSIONS: Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.

https://pediatrics.aappublications.org/content/pediatrics/early/2017/01/11/peds.2016-2927.full.pdf

Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis

Authors/Task Force Members: George E. Sarris* (Chairperson) (Greece), Christian Balmer (Switzerland), Pipina Bonou (Greece), Juan V. Comas (Spain), Eduardo da Cruz (USA), Luca Di Chiara (Italy), Roberto M. Di Donato (United Arab Emirates), José Fragata (Portugal), Tuula Eero Jokinen (Finland), George Kirvassilis (USA), Irene Lytrivi (USA), Milan Milojevic (Netherlands), Gurleen Sharland (UK), Matthias Siepe (Germany), Joerg Stein (Austria), Emanuela Valsangiacomo Büchel (Switzerland) and Pascal R. Vouhé (France)

/pdf/clinical-guidelines-for-the-management-of-patients-with-tl0qd0n6e8.pdf

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum.

Aorta-right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options.

Complete transposition of the great arteries with aortopulmonary window: surgical treatment and embryologic significance.

Background:

In total surgical correction of tetralogy of Fallot (TOF) with functioning Blalock Taussig shunts (BTS), shunt take down increased surgical time, bleeding, and might injure phrenic and recurrent laryngeal nerve and thoracic duct.



Objectives:

A routine hybrid approach using transcatheter BTS closure immediately before total surgical correction of TOF in all patients might reduce these problems. We analyze the safety and feasibility of this approach.



Methods:

Transcatheter BTS closure was achieved using single or multiple stainless steel embolization coils, Amplatzer vascular plugs, or duct occluders. When coils were released without control by bioptome forceps, coil migration in larger shunts was prevented by proximal or distal balloon occlusion.



Results:

This routine hybrid strategy was followed in 22 consecutive patients aged 1–13 years over 4-year-period and 21 procedures were successful. Among the 16 patients attempted with coils, 13 had successful closure, 2 needed Amplatzer duct occluder devices, and 1 sent for surgical shunt takedown due to acute angulation of the shunt. New Amplatzer vascular plugs were used in six patients. Bioptome was used in six patients and proximal or distal balloon occlusion of flow was used in three patients. Four patients had closure of associated aortopulmonary or chest wall collaterals.



Conclusion:

Hybrid approach using routine transcatheter closure of all BTS immediately before surgical correction of TOF shunts with coils/plugs/devices is safe, feasible, and reproducible. © 2007 Wiley-Liss, Inc.

Hybrid approach to surgical correction of tetralogy of Fallot in all patients with functioning Blalock Taussig shunts.

Congenital aortocaval fistula to the superior vena cava.

Objective:To identify risk factors for pediatric mechanical mitral valve replacement (mMVR) to improve management in this challenging population.Methods:From 1993 to 2019, 93 children underwent 119...

What Factors Should Be Considered to Improve Outcome of Mechanical Mitral Valve Replacement in Children

Fourteen infants ranging in age from 18 days to 10 months (median age = 4 months) underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) between September, 1988 and December, 1989. The anomalous drainage was supracardiac in nine, cardiac in two, infracardiac in one and mixed in one. One patient had a complex type of TAPVC. There were two hospital deaths, one a critically ill three week old infant with obstructed infracardiac TAPVC and the other with complex TAPVC. There was no late death. All twelve survivors are in NYHA functional Class 1. Postoperative echocardiography revealed unobstructed pulmonary blood flow in all of them. Surgical correction of TAPVC in infancy has been performed with gratifying results. A high index of suspicion, early diagnosis, prompt referral and an aggressive surgical approach are essential for success in this otherwise lethal condition.

Surgical treatment of total anomalous pulmonary venous connection.

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