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Early experience with pediatric cardiac intervention in Songklanagarind Hospital
Worakan Promphan1, Somkiat Sopontammarak, Somrit Jantarapratin
1Department of Pediatrics, Prince of Songkhla University, Hat Yai, Songkla 90110, Thailand. pworakan@yahoo.com
Insights
Pediatric cardiac intervention effectively treats congenital heart disease (CHD) in Thailand. Songklanagarind Hospital achieved satisfactory outcomes with acceptable complication rates for transcatheter treatments in children.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pediatric cardiac intervention is a key treatment for congenital heart disease (CHD).
- Songklanagarind Hospital is a recent addition to Thailand's network of university cardiac centers.
Purpose of the Study:
- To evaluate the outcomes and complications of transcatheter interventions for pediatric cardiac defects.
- To report on the experience of Songklanagarind Hospital in pediatric cardiac intervention.
Main Methods:
- A retrospective review of medical records from May 2000 to December 2003.
- Analysis of results and complications for various pediatric cardiac interventions.
Main Results:
- 102 pediatric cardiac interventions were performed, including patent ductus arteriosus (PDA), valvular pulmonary stenosis (VPS), cyanotic CHD (balloon atrial septostomy - BAS), aorto-pulmonary collaterals, and valvular aortic stenosis (VAS).
- Successful obliteration rates were high for coil embolization (PDA 60.4%, AP collaterals 100%) and Amplatzer duct occluder (ADO) deployment (100%).
- Percutaneous balloon valvuloplasty (PBV) significantly reduced pressure gradients in VPS and VAS. Complications were generally low, with some cases of distal embolization, hemolysis, and vascular issues.
Conclusions:
- Pediatric cardiac intervention at Songklanagarind Hospital demonstrates favorable results.
- The complication rate associated with these interventions is considered acceptable.
Background:
Nowadays, pediatric cardiac intervention is an effective optional treatment for congenital heart disease (CHD). Several cardiac centers have been established in different regions of Thailand and Songklanagarind Hospital is the newest of these university cardiac centers.
Objective:
To report results and complications of transcatheter treatment for congenital cardiac defects in Songklanagarind Hospital.
Material And Method:
The medical database was reviewed for the results and complications of different types of pediatric cardiac intervention from May, 2000 to December, 2003.
Results:
There were 102 cases of pediatric cardiac intervention. Sixty-seven were patent ductus arteriosus (PDA), 16 were valvular pulmonary stenosis (VPS), 10 were cyanotic CHD which needed balloon atrial septostomy (BAS), 8 were abnormal aorto-pulmonary (AP) collaterals, and 1 was severe valvular aortic stenosis (VAS). Coil embolization was performed in 53 patients with PDA and 8 patients with AP-collateral vessels, 32 of PDAs (60.4%) and all AP-collateral vessels (100%) were completely obliterated within 24 hours. The Amplatzer duct occluder (ADO) was deployed in 14 PDAs with 100% completely obliteration within 24 hours. In those with VPS or VAS, percutaneous balloon valvuloplasty (PBV) was the treatment of choice. The mean peak to peak systolic pressure gradient in VPS was reduced from 62.8 +/- 33.3 mmHg to 33.33 +/- 33.33 mmHg and from 76 mmHg to 49 mmHg in VAS after the procedures. In BAS, the mean diameter of atrial communication increased from 3.0 +/- 0.7 mm to 5.9 +/- 0.4 mm. In coil embolization, 8 had distal PA embolization (15%), 1 had hemolysis (2%) and 1 had decreased dorsalis pedis pulse (2%). One (7%) of the ADO-implanted patients had a weak femoral pulse. Of the VPS cases, 1 died from intractable heart failure, and 1 developed hemiparesis, from which they completely recovered within 6 months. The patient with VAS had a femoral artery complication.
Conclusion:
Pediatric cardiac intervention in Songklanagarind Hospital has satisfactory results with an acceptable complication rate.
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