Percutaneous Interventions in Structural Valvular and Congenital Heart Disease 2nd Edition by Horst Sievert ISBN 1482215640 9781482215649

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ISBN 10: 1482215640
ISBN 13: 9781482215649
Author: Horst Sievert

Percutaneous Interventions in Structural Valvular and Congenital Heart Disease 2nd Table of contents:

Section 1 Cardiac catheterization laboratory design and diagnostic modalities
1 How to design and operate a congenital-structural catheterization laboratory
Introduction
A new era
Hybrid Suite design
Personnel
Design: Space and ergonomics
Equipment
Informational management, video display, and transport
Inventory
Hybrid Cardiac Operating Suite
Summary
References
2 Operators’ credentials and institutional requirements for congenital and structural heart disease
Introduction
Operator knowledge base and training
Simulation/proctorship
Clinical research and clinical trials
Institutional requirements
Multidisciplinary team
Conclusion
References
3 Angiography
Introduction
Angiographic projections
Terminology
Biplane angiography
The cranial–LAO projections
Three-dimensional rotational angiography
Cardiac catheterization and radiation exposure
Specific lesions
Ventricular septal defect
Coarctation of the aorta
Aortic valve angiography
The Mustard baffle
The secundum atrial septal defect and the fenestrated Fontan
The bidirectional cavopulmonary connection
Pulmonary valve stenosis, Fallot’s tetralogy, and pulmonary valve atresia with intact ventricular septum
Branch pulmonary artery stenosis
Summary
References
4 Hemodynamics
Introduction
Intra-arterial or direct arterial pressure measurement
Right-sided pressure waveforms
Right-sided pressures
Right atrium
Jugular venous pulsations
Right ventricle
Pulmonary artery
Pulmonary artery capillary wedge pressure and left atrium
Left ventricle
Comparing left-sided to right-sided pressures
Important abnormalities of left ventricular tracings
Ascending aorta
Pulsus bisferiens
Pulsus alternans
Pulsus paradoxus
Cardiac output
Measurement of oxygen consumption (Fick method)
Indicator-dilution method
Thermodilution
Vascular resistance
Estimation of vascular resistance
Shunt detection and measurements
Shunt detection
Shunt measurement
Gradients and valve stenosis
Aortic valve stenosis
Low-gradient valvular aortic stenosis
Acute aortic valve regurgitation
Chronic aortic valve regurgitation
Mitral valve stenosis
Acute mitral regurgitation
Chronic mitral regurgitation
Pulmonary valve stenosis
Pulmonary valve regurgitation
Tricuspid valve stenosis
Tricuspid valve regurgitation
Cardiac Tamponade
References
5 Transesophageal 2D and 3D echocardiography guidance
Preparation
Image acquisition, analysis, and display
Live 3D catheter guidance
Imaging for structural interventions
Mitral paravalvar leak
Aortic PVL
3DTEE
Trans catheter aortic valve implantation (TAVI)
Left atrial appendage closure
Congenital interventions
ASD and PFO closure
Transseptal puncture
Summary
References
6 Intracardiac echocardiography (ICE)
Introduction
Historical perspectives and currently available systems
Imaging protocols
Standard views
Atrial septum
Stepwise protocol for ICE imaging to guide ASD or PFO closure
Stepwise protocol using ICE to guide VSD
ICE to guide aortic valve interventions
ICE to guide mitral valve interventions
ICE to guide pulmonary valve interventions
Established and evolving applications of ICE
Conclusions
References
7 Intracardiac echocardiography by Ultra ICE
Introduction
Rotational intracardiac ultrasound system
Image presentation and examination technique
Intracardiac echocardiographic axial views
Great vessels axial plane
Superior vena cava–right atrium junction axial plane
Aortic valve axial plane
Cavotricuspid isthmus axial plane
Intracardiac echocardiographic parasagittal view
Long-axis four-chamber plane
Current uses of ultra ice in the cardiac catheterization laboratory
Associated atrial septal abnormalities
Other applications of Ultra ICE
Conclusions
References
8 Cardiac computed tomography and magnetic resonance imaging in the cath-lab
Introduction
Principles of cardiac computed tomography
Image postprocessing techniques
Rationale of CT guidance in structural heart disease interventions
Overview of CT–fluoroscopy fusion
Transcatheter valve replacement
Transcatheter aortic valve replacement
Transcatheter pulmonary valve implantation
Transcatheter mitral valve-in-valve implantation
CT guidance for site-specific puncture
Left atrial appendage exclusion
Paravalvar leak closure
Alcohol septal ablation
Ventricular pseudoaneurysm closure
Percutaneous treatment of aortic coarctation
Conclusion
References
Section 2 Vascular access
9 Ultrasound guidance
Introduction
Background
Technique
Vascular access
Internal jugular vein, subclavian vein, and common carotid arterial access
Femoral venous and arterial access
Transhepatic venous access
Ultrasound-guided pericardiocentesis
Conclusions
References
10 Percutaneous transfemoral access with big sheaths
Introduction
Historical perspective
Procedures requiring large sheaths
Venous
Arterial
Obtaining access with large sheaths
Finding the “landing zone”
Contralateral access
Placement of large sheath
Hemostasis
Alternate methods
Venous hemostasis
Summary
References
11 Percutaneous subclavian access
Introduction
Anatomy
Technique
Complications
Summary
References
12 Access from the common carotid artery
Technique
Complications
Examples of applications
Conclusion
References
13 Transhepatic access
Introduction
History
Physiological anatomy
Precatheter planning
Technique
Catheter manipulations
Right heart
Right and left superior vena cava
Inferior vena cava
Right ventricle
Pulmonary artery and branches
Atrial septum and left heart structures
Atrial septum
Central line placement
Closure of the tract
Postcatheterization care
Complications
Conclusion
References
14 Transseptal left heart catheterization
Traditional technique
Echocardiographic-assisted transseptal puncture
Modified technique: Using an angioplasty guide wire for enhanced safety
Indications
Contraindications
Complications
References
15 Percutaneous transapical access
Introduction
Case selection
Contraindications
Preprocedural imaging
Percutaneous ventricular access technique
Patient preparation
Fusion imaging guidance
Technique
Access closure
Traditional surgical technique
Percutaneous technique
Multiple transapical access
Structural heart disease procedures using percutaneous transapical access
Complications
Conclusions and future directions
References
16 Recanalization methods for postcatheter vessel occlusion
Background
Clinical presentation, anatomy, and pathophysiology
History of the procedure
Technique of recanalization
Iliofemoral veins and IVC
Innominate veins and SVC
Follow-up data
Summary
References
17 Transpericardial access
Introduction
Anatomy of the pericardium
Conventional approach for epicardial therapeutic interventions
Anterior pericardial access approach
Helpful suggestions
Complications
Anterior versus conventional posterior pericardial access approach
References
18 Surgical access (transapical, transatrial, transaortic, femoral, subclavian)
Direct transaortic access
Partial upper sternotomy
Minithoracotomy in the right second intercostal space
Transapical aortic valve implantation
Transfemoral access
Subclavian access
Transatrial access
Comment
References
Section 3 Fetal and early postnatal interventions
19 Fetal cardiac interventions
Introduction
Indications
Technique
Results
Possible procedural complications
Outcomes in fetuses with AS and evolving HLHS
Outcomes in fetuses with AS, severe MR, and gigantic LA
Outcomes in fetuses with HLHS and intact or highly restrictive IAS
Outcomes in fetuses with PA/ CPS and evolving HRHS
Conclusions
References
20 Special considerations in small children and newborns
Introduction
Vascular access options in small patients
Materials
Sheaths
Guide wires
List of catheter materials often used in newborns and small patients
Diagnostic catheters
Interventional materials
Miscellaneous
Techniques
Case 1: Pulmonary valvuloplasty and arterial duct stenting in duct-dependent pulmonary circulation
Technical aspects of case 1
Case 2: Stenting of the hypoplastic aortic arch in complex duct-dependent systemic circulation
Technical aspects of case 2
Case 3: Stenting of the right ventricular outflow tract in severe tetralogy of Fallot, complicated by major aorto-pulmonary collateral arteries
Technical aspects of case 3
Case 4: Revascularization of obstructed Blalock-Taussig shunt 2 days after surgery
Technical aspects of case 4
Case 5: Recanalization of completely obstructed superior vena cava
Technical aspects of case 5
Case 6: Interventional VSD closure in infants
Technical aspects of case 6
Case 7: Stenting of a restrictive persistent foramen ovale in preterm babies
Technical aspects of case 7
A new stent concept: Breakable stent from Osypka Company in Germany
References
Section 4 Valves
21 Congenital aortic valve stenosis: Background and valvuloplasty in children and adults
Anatomy
Pathophysiology
Clinical symptoms
Indications for treatment
Alternatives
History of the procedure
Precatheter imaging
Anesthesia
Access
Protocol of hemodynamic assessment
Pressure gradients
Aortic valve area
Angiography
Balloon
Balloon diameter
Double-balloon technique
Balloon length
Balloon burst pressures
Brands available
Valvuloplasty
Postprocedure protocol
Pitfalls and problems
Postcatheter management
Results
References
22 Congenital aortic valve stenosis: Special considerations in neonates
Diagnosis, precatheterization assessment, and management
Catheterization
Technique
Retrograde approach
Antegrade approach
Combined approach
Complications
Results and follow-up
References
23 Aortic stenosis in the elderly: Background, indication for transcatheter treatment, and clinical trial results
Background
Etiology and prevalence
Pathogenesis
Risk factors
Pathophysiology
Clinical symptoms
Diagnosis
Natural history and prognosis
Medical management
Surgical management
Transcatheter treatment
Balloon valvuloplasty
Transcatheter AV implantation/transcatheter AV replacement: The history of the procedure
Transcatheter AV implantation/transcatheter AV replacement: The procedure
Indications for treatment with TAVR
Clinical trial results
Registry data
Randomized controlled trials
Quality of life
Stroke
Conduction defects
Vascular complications
Paravalvular leak
References
24 Aortic valve stenosis in the elderly: Balloon aortic valvuloplasty
Introduction and background
Indications for PTAV
Isolated PTAV
As a bridge to AVR or TAVR
Palliation
Procedural considerations
Access
Balloon sizing
Rapid pacing
Valvuloplasty techniques
Retrograde approach
Antegrade approach
Complications and postprocedure care
Current perspective and future directions
References
25 Aortic valve stenosis in the elderly: Transcatheter aortic valve implantation—Edwards SAPIEN valve
Introduction
Edwards SAPIEN transcatheter heart valve
Patient selection
“Tips and tricks” in delivering the SAPIEN system
Catheterization lab setup
Gaining access: Transfemoral approach
Sinus alignment, valve crossing, and valvuloplasty
Valve deployment
Vascular access closure
References
26 Aortic valve stenosis in the elderly: Transcatheter aortic valve implantation—CoreValve
Introduction
ADVANCE study
Annulus sizing and valve selection
CoreValve TAVI procedure
Assessing paravalvular aortic regurgitation after corevalve implantation
Corrective measures to reduce PAR after corevalve implantation
Conclusions
References
27 Aortic valve stenosis in the elderly: Valve-in-valve implantations
Primer on surgical bioprostheses and their mechanisms of failure
Preprocedural screening and planning
Procedure and implantation technique
Complications specific to VIV
Clinical data: The Global Valve-in-Valve Registry
Conclusions
Acknowledgments
References
28 Aortic valve stenosis in the elderly: New percutaneous aortic valves
Introduction
DirectFlow Medical valve
Lotus™ valve
JenaValve
Symetis Acurate valve
Portico valve
Heart Leaflet Technologies valve
References
29 Aortic valve stenosis in the elderly: Embolic protection during transcatheter aortic valve implantation
Introduction
Prevention of cerebrovascular events with dedicated embolic protection devices
Financial and competing interests disclosure
References
30 Pulmonary valve disease: Pulmonary regurgitation—Background, indications for treatment, and clinical trial results
Background
Precipitants
Tetralogy of Fallot
Balloon pulmonary valvuloplasty
Pathophysiology
Consequences of PR
LV dysfunction
Arrhythmia
Assessment
Echocardiography
Cardiac magnetic resonance
CT angiography
Diagnostic cardiac catheterization
Cardiopulmonary exercise testing
Indications for treatment
Clinical trials and outcomes
Pulmonary valve replacement: Surgical and transcatheter
Conclusions
References
31 Pulmonary valve disease: Pulmonary valve stenosis
Introduction
Anatomy and pathophysiology
Clinical features
Indications for balloon pulmonary valvuloplasty
Surgical therapy
Historical aspects of balloon pulmonary valvuloplasty
Technique
Preintervention noninvasive studies
Echo-Doppler studies
Other noninvasive studies
Sedation and anesthesia
Vascular access
Hemodynamic assessment
Angiography
Catheters/wires preparatory to balloon dilatation
Balloon dilatation catheters
Balloon diameter
Balloon length
Number of balloons
Bifoil and trefoil balloons
Pressure, number, and duration of balloon inflation
Balloon valvuloplasty procedure (step-by-step)
Postballoon protocol
Pitfalls, problems, and complications Problems
Acute complications
Complications at follow-up
Postcatheter management
References
32 Pulmonary valve disease: Pulmonary atresia
Introduction
Anatomy, initial evaluation, and patient selection
Patients who are suitable for transcatheter valvotomy and balloon dilation
Patients in whom transcatheter valvotomy and balloon dilation is inappropriate or contraindicated
Procedure and techniques
Preintervention baseline study
Valvotomy and balloon dilation
Perforation
Graded balloon dilation
Complications
Postprocedure care
Follow-up
Summary
References
33 Pulmonary valve disease: Pulmonary valve in cyanotic heart defects with pulmonary oligemia
Introduction
Indications for balloon pulmonary valvuloplasty
Technique
Complications
Discussion
References
34 Pulmonary valve disease: Transcatheter pulmonary valve implantation with the Melody valve
Anatomy/pathophysiology
Indications of pulmonary valve replacement
Class IIa
History
Precatheter assessment
Tips for case selection
Case selection
Choice of delivery system
Unusual anatomy
Postprocedure
Follow-up
References
35 Pulmonary valve disease: Transcatheter pulmonary valve implantation with the Edwards SAPIEN valve
Introduction
Edwards SAPIEN THV
Valve design
Indications
Procedural details
Complications
Literature review
Future directions
Acknowledgment
References
36 Pulmonary valve disease: New percutaneous pulmonary valves
Introduction
Anatomical Variability
New and developing transcatheter pulmonary valve systems
Evolving systems: Self-expanding transcatheter systems
The Venus P Valve
Evolving systems: Injectable valves
Evolving systems: Smaller delivery systems
Tissue engineering
Conclusions
References
37 Mitral and tricuspid valve stenosis: Percutaneous mitral valvuloplasty
Technique of PMV
Antegrade double-balloon technique
Inoue Technique of PMV
Percutaneous mitral valvotomy with a metal dilator
Double-balloon versus Inoue balloon techniques of PMV
Patient selection
Mechanism of PMV
Complications
Clinical follow-up
Percutaneous tricuspid balloon valvuloplasty
Conclusions
References
38 Mitral and tricuspid valve stenosis: Percutaneous tricuspid valvuloplasty
Tricuspid valve anatomy
Tricuspid valve
Tricuspid stenosis
Causes and pathophysiology
Epidemiology
Clinical presentation Symptoms
Physical examination
Auscultation
Diagnostic evaluation modalities
Electrocardiography
Radiography
Echocardiography
Cardiac catheterization
Management
Patient selection for valvotomy
Pregnancy
Techniques of tricuspid balloon valvotomy
Tricuspid double balloon valvotomy (Figure 38.3)
The Inoue balloon for dilatation of the tricuspid valve (Figure 38.4)
Results of balloon valvotomy
Risks
Recommendations
References
39 Mitral valve insufficiency: Background and indications for treatment
Etiology and pathology
Degenerative mitral disease
Rheumatic mitral disease
Endocarditis
Functional mitral regurgitation
Pathophysiology
Clinical evaluation
Symptoms and physical examination
Echocardiography
Exercise testing
Cardiac catheterization
Magnetic resonance imaging
Treatment rationale, options, and timing of therapy
Natural history of mitral regurgitation
Serial monitoring
Physical activity and exercise
Atrial fibrillation
Medical therapy
Cardiac resynchronization therapy
Surgical approaches
Percutaneous approaches
Data behind mitral valve repair and replacement
Controversies: Surgical coronary artery disease and moderate-severe ischemic mitral regurgitation
Controversies: Moderate-to-severe mitral valve regurgitation and congestive heart failure
Indications for therapy in patients with primary mitral regurgitation
Indications for therapy in patients with secondary mitral regurgitation
References
40 Mitral valve insufficiency: Mitral valve repair with the MitraClip
Introduction
Indication of mitral valve repair with MitraClip
MitraClip device system
Procedural steps; keys and tips for a successful MitraClip procedure
Potential complications and postprocedure care
Safety, feasibility, and clinical outcomes
Future perspective and conclusions
References
41 Mitral valve insufficiency: Other new mitral valve repair techniques
Indirect annuloplasty
Direct annuloplasty
LV chamber remodeling with annuloplasty
Chordal replacement
Mitral Spacer
Valve replacement
Conclusion
References
42 Mitral valve insufficiency: Transcatheter mitral valve implantation
Introduction
Surgical therapies for mitral regurgitation (repair vs. replacement)
Limitations of mitral valve repair
Chordal-sparing mitral replacement
Transcatheter mitral valve implantation
Trials of TMVI
Future directions
References
43 Tricuspid valve insufficiency: Background and indications for treatment
Introduction
Anatomy and function of the tricuspid valve
Natural history and pathophysiology of tricuspid regurgitation
Echocardiographic assessment and grading of tricuspid regurgitation
Indications for treatment
Current techniques for TV surgery
Disclosures
References
44 Tricuspid valve insufficiency: Melody valve in the tricuspid position
Introduction
Preparation
Catheterization
Discussion
References
45 Tricuspid valve insufficiency: SAPIEN valve in the tricuspid position
Introduction
Indications for percutaneous TVR
Edwards SAPIEN valve
Advantages of the SAPIEN valve
Disadvantages of the SAPIEN valve
Procedure
Imaging
Femoral approach
SVC (transjugular) approach
Transatrial approach
Pacing
Sizing considerations
Conclusion
References
46 Tricuspid valve insufficiency: Percutaneous caval stent valve implantation for treatment of tricuspid insufficiency
Introduction
Challenges associated with interventional treatment of native tricuspid valve insufficiency
Percutaneous valve implantation for treatment of insufficiency of the native tricuspid valve
Summary
Acknowledgment
Disclosures
References
47 Tricuspid valve insufficiency: Catheter closure of paravalvular leaks
Introduction
Paravalvular leak: Imaging
Paravalvular leak: Location
Paravalvular leak: Sizing
Paravalvular leak: Access
Paravalvular leak: Device selection
Putting it all together: Aortic PVL
Putting it all together: Mitral PVL
Device success
Special situations
Multiple leaks
Preserving PVL access with device placement
Complications
Long-term survival
References
48 Tricuspid valve insufficiency: Catheter closure of perforated sinus of Valsalva
Introduction
Presentation
Investigations
Electrocardiogram
Chest radiography
Echocardiogram/Doppler
Angiography
Computerized tomography/cardiac magnetic resonance (CMR)
Indications for intervention
Catheter intervention
General
Equipment
Procedure
Postprocedure management
Indications for surgery
Complications
Results
Conclusion
Acknowledgments
References
Section 5 Septal defects
49 Atrial septal defect: Background and indications for ASD closure
Definition
Physiology
Diagnosis
Effects
Indications for closure
Timing
Contraindications
Summary
References
50 Atrial septal defect: Amplatzer-type ASD occluders
Introduction
Amplatzer device
Amplatzer delivery system
Optional but recommended equipment
Amplatzer sizing balloon
NuMED sizing balloons
Amplatzer Super Stiff exchange guide wire—0.035 inch
Occlutech ASD device
Patient selection
Precatheterization evaluation
Transcatheter closure of secundum ASD: Step-by-step technique
Materials and equipment
Personnel
Procedure
Results
Complications/problems encountered during ASD closure
General remarks
References
51 The Figulla-Occlutech device
Introduction
Device
Delivery system
Additional equipment
Sizing balloons
Delivery sheaths
Patient selection
Precatheterization evaluation
Device implantation technique
Postprocedure follow-up
Results
Complications with the Figulla occluder
Conclusions
Acknowledgment
References
52 The Cera Lifetech device
Introduction
The device
The delivery system
Patient selection
Implantation procedure
Results
Conclusion
References
53 ASD-R PFM device
Introduction
The device
Experiences and outcomes
Conclusions
Acknowledgments
References
54 Cocoon device
Introduction
The device and loading system
Patient selection
Implantation procedure
Results
Conclusion
References
55 Starway device
Device introduction
Patient selection
ASD device implantation
Results
Complications
Discussion
Conclusion
Acknowledgments
References
56 Atrial septal defect: Cardia ASD occluder
Introduction
Device description and technical solution implemented over time to improve the Cardia performance
Procedural aspects of Atriasept ASD closure
References
57 Atrial septal defect: Complications of device closure of ASDs
Introduction
Procedural complications
Arrhythmia
Postprocedural tachyarrhythmias
Embolization
Erosion
Pulmonary edema
Thromboembolism
References
58 Patent foramen ovale closure: Background, indications for closure, and clinical trial results
Introduction
Background
Cryptogenic stroke and PFO
Migraine headaches and PFO
PFO closure
Cryptogenic stroke
Migraine headaches
Clinical trial results
Cryptogenic stroke
More recent studies
Migraine Headaches
Conclusions
References
59 Patent foramen ovale closure: Amplatzer-type PFO occluders
Introduction
Technique of Amplatzer PFO occluder implantation
Echocardiography properties relevant for PFO closure
Implantation procedure
Important points to check before releasing the device
Complications and follow-up examinations after Amplatzer PFO occlusion
Use of the Amplatzer atrial septal defect occluder for PFO closure
Pitfalls of Amplatzer PFO occluder implantation
Incidental angiographic diagnoses of PFO
General remarks
References
60 Disorders of the atrial septum: Closure with HELEX or Gore septal occluder
HELEX device
Sizing and anatomical compatibility
Procedure
Complications and management
Follow-up and medication
Published outcomes
Gore septal occluder
Procedure

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