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Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.
Shyam Sathanandam; Dan Gutfinger; Brian Morray; Darren Berman; Matthew Gillespie; Thomas Forbes; Jason N. Johnson; Ruchira Garg; Sophie Malekzadeh-Milani; Alain Fraisse; Osman Baspinar; Evan M. Zahn. Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants. Pediatric Cardiology 2021, 42, 1 -17.
AMA StyleShyam Sathanandam, Dan Gutfinger, Brian Morray, Darren Berman, Matthew Gillespie, Thomas Forbes, Jason N. Johnson, Ruchira Garg, Sophie Malekzadeh-Milani, Alain Fraisse, Osman Baspinar, Evan M. Zahn. Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants. Pediatric Cardiology. 2021; 42 (6):1-17.
Chicago/Turabian StyleShyam Sathanandam; Dan Gutfinger; Brian Morray; Darren Berman; Matthew Gillespie; Thomas Forbes; Jason N. Johnson; Ruchira Garg; Sophie Malekzadeh-Milani; Alain Fraisse; Osman Baspinar; Evan M. Zahn. 2021. "Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants." Pediatric Cardiology 42, no. 6: 1-17.
Background Transthoracic echocardiography (TTE) is increasingly utilized for guiding transcatheter closure of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objectives of this study were to compare PDA size measurements by TTE with angiographic measurements and to describe TTE techniques used in guiding transcatheter PDA closure (TCPC) in ELBW infants. Methods One hundred twenty-five consecutive ELBW infants (gestational age < 27 weeks, birth weight < 1 kg) who underwent TCPC before 8 weeks of age under TTE guidance were included. Patent ductus arteriosus sizes were measured from the procedural TTE and angiograms retrospectively by blinded observers. The TTE PDA diameters at the aortic (ED1) and pulmonary end (ED2) were compared with the corresponding angiographic diameters (CD1 and CD2). The TTE PDA lengths, obtained by two techniques (EL1, a straight line between ED1 and ED2; and EL2, a curvilinear line along the PDA), were compared with the PDA length by angiography (CL). Transthoracic echocardiography was used to guide accurate device positioning within the PDA. Results The procedure weight was 600-1,460 g. The TTE and angiographic PDA diameters were comparable (mean ED1 vs CD1 = 4.5 ± 0.68 vs 4.4 ± 0.85 mm, P = .26; and mean ED2 vs CD2 = 3.1 ± 0.72 vs 3.2 ± 0.94 mm, P = .14). The angiographic length was underestimated by EL1 by 2.6 ± 1.6 mm (P< .0001), while EL2 estimated it better (mean EL2 vs CL = 11.0 ± 1.83 vs 10.8 ± 2.15 mm; P = .40). Transcatheter PDA closure was successful in 100% of the cases using TTE guidance. There were no intraprocedural complications. Conclusions Transthoracic echocardiography guidance during TCPC in ELBW infants eliminates the need for aortograms via femoral arterial access, preventing the complications associated with it. Transthoracic echocardiography PDA measurements are comparable to angiographic measurements, thereby assisting in appropriate device size selection.
Govinda Paudel; Jason N. Johnson; Ranjit Philip; Neil Tailor; Sarah Fahnhorst; Mario Briceno-Medina; Nathan Stecchi; B. Rush Waller; Shyam Sathanandam. Echocardiographic versus Angiographic Measurement of the Patent Ductus Arteriosus in Extremely Low Birth Weight Infants and the Utility of Echo Guidance for Transcatheter Closure. Journal of the American Society of Echocardiography 2021, 1 .
AMA StyleGovinda Paudel, Jason N. Johnson, Ranjit Philip, Neil Tailor, Sarah Fahnhorst, Mario Briceno-Medina, Nathan Stecchi, B. Rush Waller, Shyam Sathanandam. Echocardiographic versus Angiographic Measurement of the Patent Ductus Arteriosus in Extremely Low Birth Weight Infants and the Utility of Echo Guidance for Transcatheter Closure. Journal of the American Society of Echocardiography. 2021; ():1.
Chicago/Turabian StyleGovinda Paudel; Jason N. Johnson; Ranjit Philip; Neil Tailor; Sarah Fahnhorst; Mario Briceno-Medina; Nathan Stecchi; B. Rush Waller; Shyam Sathanandam. 2021. "Echocardiographic versus Angiographic Measurement of the Patent Ductus Arteriosus in Extremely Low Birth Weight Infants and the Utility of Echo Guidance for Transcatheter Closure." Journal of the American Society of Echocardiography , no. : 1.
Ranjit Philip; Neil Tailor; Jason N. Johnson; Leah Apalodimas; Jorden Cunningham; Judy Hoy; B. Rush Waller Iii; Shyam Sathanandam. Single-Center Experience of 100 Consecutive Percutaneous Patent Ductus Arteriosus Closures in Infants ≤1000 Grams. Circulation: Cardiovascular Interventions 2021, 14, e010600 .
AMA StyleRanjit Philip, Neil Tailor, Jason N. Johnson, Leah Apalodimas, Jorden Cunningham, Judy Hoy, B. Rush Waller Iii, Shyam Sathanandam. Single-Center Experience of 100 Consecutive Percutaneous Patent Ductus Arteriosus Closures in Infants ≤1000 Grams. Circulation: Cardiovascular Interventions. 2021; 14 (6):e010600.
Chicago/Turabian StyleRanjit Philip; Neil Tailor; Jason N. Johnson; Leah Apalodimas; Jorden Cunningham; Judy Hoy; B. Rush Waller Iii; Shyam Sathanandam. 2021. "Single-Center Experience of 100 Consecutive Percutaneous Patent Ductus Arteriosus Closures in Infants ≤1000 Grams." Circulation: Cardiovascular Interventions 14, no. 6: e010600.
Objectives This study sought to obtain in vivo data on a new stent and delivery system specifically designed for implantation in infants with the ability to be enlarged to adult dimensions. Background There are no endovascular stents designed for or approved for use in infants, nor is there a stent capable of being implanted at infant vessel diameters and achieving adult size while maintaining structural integrity. The Minima stent was designed to address these needs. Methods This study was performed in 6 piglets who underwent implantation of 22 Minima stents into the following locations: aorta (n = 11), branch pulmonary arteries (n = 6), and central veins (n = 5). Results Successful deployment occurred in 21/22 attempts. Two instances of post‐deployment migration occurred. Stents were re‐expanded at 1, 2, 3 and 5 months after implant. All stents regardless of location could be re‐dilated to the intended diameter to keep pace with somatic growth (implant diameter 6.9 +/− 1.2 mm; final diameter 16.1 mm +/− 1.4 mm). Histopathology at 1 and 5 months demonstrated widely patent vessel lumens with stent apposition to vessel wall, early mild inflammatory response surrounding stent struts, typical vascular damage and healing response to acute dilation and a progressive smooth neointimal growth covering stent struts over time. Conclusions In this in vivo study of the Minima stent, there was high implant success, predictable re‐dilatability to adult diameters and favorable histopathology. Further study is warranted.
Evan M. Zahn; Eason Abbott; Neil Tailor; Shyam Sathanandam; Dustin Armer. Preliminary testing and evaluation of the renata minima stent, an infant stent capable of achieving adult dimensions. Catheterization and Cardiovascular Interventions 2021, 98, 117 -127.
AMA StyleEvan M. Zahn, Eason Abbott, Neil Tailor, Shyam Sathanandam, Dustin Armer. Preliminary testing and evaluation of the renata minima stent, an infant stent capable of achieving adult dimensions. Catheterization and Cardiovascular Interventions. 2021; 98 (1):117-127.
Chicago/Turabian StyleEvan M. Zahn; Eason Abbott; Neil Tailor; Shyam Sathanandam; Dustin Armer. 2021. "Preliminary testing and evaluation of the renata minima stent, an infant stent capable of achieving adult dimensions." Catheterization and Cardiovascular Interventions 98, no. 1: 117-127.
There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a difference in long-term benefits remains. This article intends to review the pulmonary vasculature changes that can occur with a chronic hemodynamically significant PDA in a preterm infant. It also explains the rationale and decision-making involved in a diagnostic cardiac catheterization and transcatheter PDA closure in these preterm infants.
Ranjit Philip; Vineet Lamba; Ajay Talati; Shyam Sathanandam. Pulmonary Hypertension with Prolonged Patency of the Ductus Arteriosus in Preterm Infants. Children 2020, 7, 139 .
AMA StyleRanjit Philip, Vineet Lamba, Ajay Talati, Shyam Sathanandam. Pulmonary Hypertension with Prolonged Patency of the Ductus Arteriosus in Preterm Infants. Children. 2020; 7 (9):139.
Chicago/Turabian StyleRanjit Philip; Vineet Lamba; Ajay Talati; Shyam Sathanandam. 2020. "Pulmonary Hypertension with Prolonged Patency of the Ductus Arteriosus in Preterm Infants." Children 7, no. 9: 139.
Objectives Characterize the safety and effectiveness of the Amplatzer Piccolo Occluder for patent ductus arteriosus (PDA) closure. Background The presence of a hemodynamically significant PDA has been associated with an increased risk of morbidity and mortality in children born premature. Methods This was a single arm, prospective, multicenter, non‐randomized study to evaluate the Amplatzer Piccolo Occluder to treat PDA in patients ≥700 g. From June 2017 to February 2019, 200 patients were enrolled at nine centers, with 100 patients weighing ≤2 kg. Primary effectiveness endpoint was the rate of PDA closure at 6‐month follow‐up. Primary safety endpoint was the rate of major complications through 6 months. Secondary endpoint was rate of significant pulmonary or aortic obstruction through 6 months' follow‐up. Results The implant success rate was 95.5% (191/200) overall and 99% in patients ≤2 kg (99/100). The primary effectiveness endpoint was achieved in 99.4% of implanted patients. Four patients experienced a primary safety endpoint event (2 transfusions, 1 hemolysis, and 1 aortic obstruction). There were no branch pulmonary artery obstructions. Five patients, all ≤2 kg, were noted to have worsening of tricuspid regurgitation (TR) after the procedure. None of the TR incidences manifested clinically. The Amplatzer Piccolo Occluder received FDA approval in January 2019 and became the first device approved for PDA closure in patients ≥700 g. Conclusions This study supports the safety and effectiveness of the Amplatzer Piccolo Occluder, particularly in patients between 700 g and 2 kg where there is currently a significant unmet need in the United States. ClinicalTrials.gov identifier: NCT03055858.
Shyam K. Sathanandam; Dan Gutfinger; Laura O'brien; Thomas J. Forbes; Matthew J. Gillespie; Darren P. Berman; Aimee K. Armstrong; Shabana Shahanavaz; Thomas K. Jones; Brian H. Morray; Toby A. Rockefeller; Henri Justino; David G. Nykanen; Evan M. Zahn. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheterization and Cardiovascular Interventions 2020, 96, 1266 -1276.
AMA StyleShyam K. Sathanandam, Dan Gutfinger, Laura O'brien, Thomas J. Forbes, Matthew J. Gillespie, Darren P. Berman, Aimee K. Armstrong, Shabana Shahanavaz, Thomas K. Jones, Brian H. Morray, Toby A. Rockefeller, Henri Justino, David G. Nykanen, Evan M. Zahn. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheterization and Cardiovascular Interventions. 2020; 96 (6):1266-1276.
Chicago/Turabian StyleShyam K. Sathanandam; Dan Gutfinger; Laura O'brien; Thomas J. Forbes; Matthew J. Gillespie; Darren P. Berman; Aimee K. Armstrong; Shabana Shahanavaz; Thomas K. Jones; Brian H. Morray; Toby A. Rockefeller; Henri Justino; David G. Nykanen; Evan M. Zahn. 2020. "Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams." Catheterization and Cardiovascular Interventions 96, no. 6: 1266-1276.
To evaluate whether avoidance of a risk factor associated with loss of pulse (LOP) following femoral artery (FA) catheterization in infants identified from previous study, was associated with decreased incidence of LOP during a prospective evaluation. Since initiation of routine ultrasound guided femoral arterial access (UGFAA) for infants undergoing catheterization in Jan 2003-Dec 2011 (Period-1), our incidence of LOP had stayed steady. Prospective evaluation between Jan 2012-Dec 2014 (Period-2), identified FA-diameter < 3 mm as risk factor for LOP. Between Jan 2015-Dec 2018 (Period-3), an initiative to avoid UGFAA for FA-diameter < 3 mm was implemented to determine whether that led to a decreased incidence of LOP. FA-diameter was measured prior to USGFAA and ratio of outer diameter of arterial sheath to luminal diameter of cannulated artery (OD/AD ratio) was calculated during Periods-2 and 3. The incidence and risk factors for LOP were assessed during the three periods. FA-access rates dropped significantly during Period-3 (56.7% vs. 93.8% and 90.4% during Periods-1 and 2, respectively, p < 0.001). Incidence of LOP in Period-3 decreased to 2.7% compared to 12.5% (Period-1) and 17.4% (Period-2) (p < 0.001). By multivariate analysis, FA size < 3 mm and an OD/AD ratio > 40% were the only significant independent predictors for LOP (OR 6.48, 95% CI 2.3-11.42, p < 0.001 and OR 4.16, 95% CI 1.79-8.65, p < 0.01, respectively). Access of femoral artery < 3 mm and OD/AD ratio > 50% are associated with increased incidence of LOP. Avoidance of these factors may help decrease complications in infants undergoing cardiac catheterizations.
Sachin Tadphale; Thomas Yohannan; Travis Kauffmann; Vinod Maller; Vijaykumar Agrawal; Hannah Lloyd; B. Rush Waller; Shyam Sathanandam. Accessing Femoral Arteries Less than 3 mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants. Pediatric Cardiology 2020, 41, 1058 -1066.
AMA StyleSachin Tadphale, Thomas Yohannan, Travis Kauffmann, Vinod Maller, Vijaykumar Agrawal, Hannah Lloyd, B. Rush Waller, Shyam Sathanandam. Accessing Femoral Arteries Less than 3 mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants. Pediatric Cardiology. 2020; 41 (5):1058-1066.
Chicago/Turabian StyleSachin Tadphale; Thomas Yohannan; Travis Kauffmann; Vinod Maller; Vijaykumar Agrawal; Hannah Lloyd; B. Rush Waller; Shyam Sathanandam. 2020. "Accessing Femoral Arteries Less than 3 mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants." Pediatric Cardiology 41, no. 5: 1058-1066.
The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0–4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child’s age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0–4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0–4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.
Sachin D. Tadphale; David Zurakowski; Lindsey E. Bird; Thomas M. Yohannan; Vijaykumar K. Agrawal; Hannah G. Lloyd; Kimberly J. Allen; B. Rush Waller; Amber M. Hall; Shyam Sathanandam. Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0–4 Years Old. Pediatric Cardiology 2020, 41, 1135 -1144.
AMA StyleSachin D. Tadphale, David Zurakowski, Lindsey E. Bird, Thomas M. Yohannan, Vijaykumar K. Agrawal, Hannah G. Lloyd, Kimberly J. Allen, B. Rush Waller, Amber M. Hall, Shyam Sathanandam. Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0–4 Years Old. Pediatric Cardiology. 2020; 41 (6):1135-1144.
Chicago/Turabian StyleSachin D. Tadphale; David Zurakowski; Lindsey E. Bird; Thomas M. Yohannan; Vijaykumar K. Agrawal; Hannah G. Lloyd; Kimberly J. Allen; B. Rush Waller; Amber M. Hall; Shyam Sathanandam. 2020. "Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0–4 Years Old." Pediatric Cardiology 41, no. 6: 1135-1144.
Patent ductus arteriosus (PDA) is the most common cardiovascular condition afflicting premature neonates especially those born extremely low birth weight (ELBW). Despite five decades of scientific inquiry which has produced thousands of publications including over 65 randomized controlled trials, cardiologists, neonatologists, and surgeons still cannot answer simple questions such as if, when and how to close to the PDA in ELBW infants. This chapter will examine current evidence in order to answer these fundamental questions. The chapter will specifically focus on transcatheter PDA closure (TCPC), which albeit a new therapy, has displayed great potential to be the best therapeutic option in the future. It is about time that physicians from all sub-specialties come together and integrate the evidence to develop a management algorithm for ELBW infants with hemodynamically significant PDA.
Stephanie Whiting; Shyam Sathanandam. PDA Closure in ELBW Infants: If, When, and How to Do It. Update on Critical Issues on Infant and Neonatal Care 2020, 1 .
AMA StyleStephanie Whiting, Shyam Sathanandam. PDA Closure in ELBW Infants: If, When, and How to Do It. Update on Critical Issues on Infant and Neonatal Care. 2020; ():1.
Chicago/Turabian StyleStephanie Whiting; Shyam Sathanandam. 2020. "PDA Closure in ELBW Infants: If, When, and How to Do It." Update on Critical Issues on Infant and Neonatal Care , no. : 1.
Brian H Morray; Brent M Gordon; Matthew A Crystal; Bryan H Goldstein; Athar M Qureshi; Alejandro J Torres; Shilpi M Epstein; Ivory Crittendon; Frank F Ing; Shyam K Sathanandam. Resource Allocation and Decision Making for Pediatric and Congenital Cardiac Catheterization During the Novel Coronavirus SARS-CoV-2 (COVID-19) Pandemic: A U.S. Multi-Institutional Perspective. 2020, 1 .
AMA StyleBrian H Morray, Brent M Gordon, Matthew A Crystal, Bryan H Goldstein, Athar M Qureshi, Alejandro J Torres, Shilpi M Epstein, Ivory Crittendon, Frank F Ing, Shyam K Sathanandam. Resource Allocation and Decision Making for Pediatric and Congenital Cardiac Catheterization During the Novel Coronavirus SARS-CoV-2 (COVID-19) Pandemic: A U.S. Multi-Institutional Perspective. . 2020; ():1.
Chicago/Turabian StyleBrian H Morray; Brent M Gordon; Matthew A Crystal; Bryan H Goldstein; Athar M Qureshi; Alejandro J Torres; Shilpi M Epstein; Ivory Crittendon; Frank F Ing; Shyam K Sathanandam. 2020. "Resource Allocation and Decision Making for Pediatric and Congenital Cardiac Catheterization During the Novel Coronavirus SARS-CoV-2 (COVID-19) Pandemic: A U.S. Multi-Institutional Perspective." , no. : 1.
Ranjit Philip; Benjamin Waller; Sandeep Chilakala; Leah Apalodimas; Shyam Sathanandam. COMPARISON OF LOW CARDIAC OUTPUT SYNDROME AFTER PDA LIGATION AND TRANSCATHETER PDA CLOSURE IN EXTREMELY LOW BIRTH WEIGHT INFANTS. Journal of the American College of Cardiology 2019, 73, 575 .
AMA StyleRanjit Philip, Benjamin Waller, Sandeep Chilakala, Leah Apalodimas, Shyam Sathanandam. COMPARISON OF LOW CARDIAC OUTPUT SYNDROME AFTER PDA LIGATION AND TRANSCATHETER PDA CLOSURE IN EXTREMELY LOW BIRTH WEIGHT INFANTS. Journal of the American College of Cardiology. 2019; 73 (9):575.
Chicago/Turabian StyleRanjit Philip; Benjamin Waller; Sandeep Chilakala; Leah Apalodimas; Shyam Sathanandam. 2019. "COMPARISON OF LOW CARDIAC OUTPUT SYNDROME AFTER PDA LIGATION AND TRANSCATHETER PDA CLOSURE IN EXTREMELY LOW BIRTH WEIGHT INFANTS." Journal of the American College of Cardiology 73, no. 9: 575.
Ranjit Philip; Shyam Sathanandam; Neil Tailor; Leah Apalodimas; Stepanie Whiting; Randall Buddington. A SWINE MODEL FOR THE PREMATURE INFANT PATENT DUCTUS ARTERIOSUS. Journal of the American College of Cardiology 2019, 73, 1686 .
AMA StyleRanjit Philip, Shyam Sathanandam, Neil Tailor, Leah Apalodimas, Stepanie Whiting, Randall Buddington. A SWINE MODEL FOR THE PREMATURE INFANT PATENT DUCTUS ARTERIOSUS. Journal of the American College of Cardiology. 2019; 73 (9):1686.
Chicago/Turabian StyleRanjit Philip; Shyam Sathanandam; Neil Tailor; Leah Apalodimas; Stepanie Whiting; Randall Buddington. 2019. "A SWINE MODEL FOR THE PREMATURE INFANT PATENT DUCTUS ARTERIOSUS." Journal of the American College of Cardiology 73, no. 9: 1686.
Background A surgical pulmonary artery band (PAB) is used to control excessive pulmonary blood flow for certain congenital heart diseases. Previous attempts have been made to develop a transcatheter, implantable pulmonary flow restrictor (PFR) without great success. We modified a microvascular plug (MVP) to be used as a PFR. The objectives of this study were to demonstrate feasibility of transcatheter implantation and retrieval of the modified MVP as a PFR, and compare PA growth while using the PFR versus PAB. Methods and results The PFR was implanted in eight newborn piglets in bilateral branch pulmonary arteries (PAs). Immediately post‐PFR implantation, the right ventricular systolic pressure increased from a median of 20–51 mmHg. Transcatheter retrieval of PFR was 100% successful at 3, 6, and 9 weeks and 50% at 12‐weeks post‐implant. A left PAB was placed via thoracotomy in four other newborn piglets. Debanding was performed 6‐weeks later via balloon angioplasty. On follow‐up, the proximal left PA diameters in the PFR and the PAB groups were similar (median 8 vs. 7.1 mm; p = 0.11); albeit the surgical band sites required repeat balloon angioplasty secondary to recurrent stenosis. By histopathology, there was grade II vessel injury in two pigs immediately post‐retrieval of PFR that healed by 12 weeks. Conclusions Transcatheter implantation and retrieval of the MVP as a PFR is feasible. PA growth is comparable to surgical PAB, which is likely to require reinterventions. The use of the MVP as a PFR in humans has to be trialed before recommending its routine use.
Abdul H. Khan; Deepthi Hoskoppal; Tk Susheel Kumar; Lindsey Bird; Kimberly Allen Rn; Hannah Lloyd; Christopher J. Knott-Craig; B. Rush Waller; Shyam Sathanandam. Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model. Catheterization and Cardiovascular Interventions 2019, 93, 1320 -1328.
AMA StyleAbdul H. Khan, Deepthi Hoskoppal, Tk Susheel Kumar, Lindsey Bird, Kimberly Allen Rn, Hannah Lloyd, Christopher J. Knott-Craig, B. Rush Waller, Shyam Sathanandam. Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model. Catheterization and Cardiovascular Interventions. 2019; 93 (7):1320-1328.
Chicago/Turabian StyleAbdul H. Khan; Deepthi Hoskoppal; Tk Susheel Kumar; Lindsey Bird; Kimberly Allen Rn; Hannah Lloyd; Christopher J. Knott-Craig; B. Rush Waller; Shyam Sathanandam. 2019. "Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model." Catheterization and Cardiovascular Interventions 93, no. 7: 1320-1328.
Objective The objective of this article is to describe a live case transmission of transcatheter closure of a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) infant during the first International PDA Symposium conducted in Memphis, Tennessee. Setting A multidisciplinary team approach including audiovisual specialists, information technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children’s Hospital and the procedure was broadcast live to the attendees at the International PDA Symposium allowing for a two‐way audiovisual discussion during the procedure. Patient The patient was a 14 days old 24‐week premature ELBW infant, who weighed 700 g at the time of the procedure. The patient was requiring mechanical ventilation secondary to pulmonary hemorrhage. The PDA measured 4 mm in diameter and 12 mm in length. Interventions TCPC was performed safely without any procedural complications using a specialized minimally invasive technique. Outcome Measures The patient was weaned off the ventilator in < 7 days after the procedure. The child was discharged 9 weeks after the procedure (35 weeks’ corrected gestation) weighing 2.2 kg, on full oral feeds and no supplemental oxygen. Results The successful TCPC allowed for this child to have an uneventful hospital course. The case also highlights the technical nuances involved in setting up the live transmission. Conclusions This case demonstrated to the audience in the International PDA Symposium the feasibility and safety of performing TCPC in an ELBW infant. Live cases are useful in exhibiting the nuances involved in any new technique and allows for best learning experience.
Shyam Sathanandam; Ashley Gianinni; Eric Sefton; Kaitlyn Greer; Nathan Stecchi; Kimberly Allen; Ranjit Philip; B. Rush Waller. Live broadcast of transcatheter PDA closure in a 700 grams ELBW infant during the International PDA Symposium. Congenital Heart Disease 2019, 14, 85 -89.
AMA StyleShyam Sathanandam, Ashley Gianinni, Eric Sefton, Kaitlyn Greer, Nathan Stecchi, Kimberly Allen, Ranjit Philip, B. Rush Waller. Live broadcast of transcatheter PDA closure in a 700 grams ELBW infant during the International PDA Symposium. Congenital Heart Disease. 2019; 14 (1):85-89.
Chicago/Turabian StyleShyam Sathanandam; Ashley Gianinni; Eric Sefton; Kaitlyn Greer; Nathan Stecchi; Kimberly Allen; Ranjit Philip; B. Rush Waller. 2019. "Live broadcast of transcatheter PDA closure in a 700 grams ELBW infant during the International PDA Symposium." Congenital Heart Disease 14, no. 1: 85-89.
The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long‐standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension.
Ranjit Philip; Jason Nathaniel Johnson; Ronak Naik; Dai Kimura; Umar Boston; Sandeep Chilakala; Benjamin Hendrickson; Benjamin Rush Waller; Shyam Sathanandam. Effect of patent ductus arteriosus on pulmonary vascular disease. Congenital Heart Disease 2019, 14, 37 -41.
AMA StyleRanjit Philip, Jason Nathaniel Johnson, Ronak Naik, Dai Kimura, Umar Boston, Sandeep Chilakala, Benjamin Hendrickson, Benjamin Rush Waller, Shyam Sathanandam. Effect of patent ductus arteriosus on pulmonary vascular disease. Congenital Heart Disease. 2019; 14 (1):37-41.
Chicago/Turabian StyleRanjit Philip; Jason Nathaniel Johnson; Ronak Naik; Dai Kimura; Umar Boston; Sandeep Chilakala; Benjamin Hendrickson; Benjamin Rush Waller; Shyam Sathanandam. 2019. "Effect of patent ductus arteriosus on pulmonary vascular disease." Congenital Heart Disease 14, no. 1: 37-41.
There continues to be controversy on the long‐term effects of a patent ductus arteriosus (PDA) and its management. However, the hemodynamic effects of a large PDA in a preterm infant are well known. This article aims to provide insight into the adaptive changes and remodeling effects of a PDA on the myocardium in preterm infants.
Ranjit Philip; Jeffrey A. Towbin; Shyam Sathanandam; Jason Goldberg; Thomas Yohannan; Nithya Swaminathan; Jason Nathaniel Johnson. Effect of patent ductus arteriosus on the heart in preterm infants. Congenital Heart Disease 2019, 14, 33 -36.
AMA StyleRanjit Philip, Jeffrey A. Towbin, Shyam Sathanandam, Jason Goldberg, Thomas Yohannan, Nithya Swaminathan, Jason Nathaniel Johnson. Effect of patent ductus arteriosus on the heart in preterm infants. Congenital Heart Disease. 2019; 14 (1):33-36.
Chicago/Turabian StyleRanjit Philip; Jeffrey A. Towbin; Shyam Sathanandam; Jason Goldberg; Thomas Yohannan; Nithya Swaminathan; Jason Nathaniel Johnson. 2019. "Effect of patent ductus arteriosus on the heart in preterm infants." Congenital Heart Disease 14, no. 1: 33-36.
Douglas S. Moodie; Shyam Sathanandam; Athar M. Qureshi. Proceedings of the International PDA Symposium. Congenital Heart Disease 2019, 14, 5 -5.
AMA StyleDouglas S. Moodie, Shyam Sathanandam, Athar M. Qureshi. Proceedings of the International PDA Symposium. Congenital Heart Disease. 2019; 14 (1):5-5.
Chicago/Turabian StyleDouglas S. Moodie; Shyam Sathanandam; Athar M. Qureshi. 2019. "Proceedings of the International PDA Symposium." Congenital Heart Disease 14, no. 1: 5-5.
Objective The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center’s neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA). Setting Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure. A multidisciplinary team approach is necessary in order to achieve a safe transport of these fragile patients. Patients To date, we have over 12 centers referring patients that weigh <1000 g for transcatheter PDA closure (TCPC). Three of these centers are over 300 miles away. Five other centers are between 100 and 300 miles from the hospital in which we perform TCPC. Interventions Fixed‐wing aircrafts are necessary for long‐distance transfers. Various modes of mechanical ventilators including transport oscillators are built into temperature‐ and humidity‐controlled incubators in which these infants are transported. Ambulances are used to take the patient between the airport and the hospital. Shorter distance transports are accomplished via helicopters or ambulances. Transfer from the NICU to the catheterization lab to perform TCPC is a relatively easier endeavor. Outcome Measures Patients’ body temperature, fluid balance, and hemodynamics have to be maintained throughout the transport and the procedure for best outcomes. Results There has been 100% procedural success of performing TCPC in ELBW infants with no hemodynamic compromise during transport. Conclusions TCPC has shown promise in improving overall patient outcomes that the potential hazards associated with complex transport measures are worth it. Successful transfer to and from referring centers and to and from the catheterization lab can be accomplished safely with increasing institutional experience.
Adam Willis; Lillia Pereiras; Tim Head; Genevieve Dupuis; Janet Sessums; Gordon Corder; Kim Graves; Jack Tipton; Shyam Sathanandam. Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab. Congenital Heart Disease 2019, 14, 69 -73.
AMA StyleAdam Willis, Lillia Pereiras, Tim Head, Genevieve Dupuis, Janet Sessums, Gordon Corder, Kim Graves, Jack Tipton, Shyam Sathanandam. Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab. Congenital Heart Disease. 2019; 14 (1):69-73.
Chicago/Turabian StyleAdam Willis; Lillia Pereiras; Tim Head; Genevieve Dupuis; Janet Sessums; Gordon Corder; Kim Graves; Jack Tipton; Shyam Sathanandam. 2019. "Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab." Congenital Heart Disease 14, no. 1: 69-73.
Patent ductus arteriosus (PDA) in extremely low-birth-weight infants puts this vulnerable population at high risks of morbidity and mortality. Inclusion of a multidisciplinary team and newly available transcatheter PDA occlusion devices in the management of these infants can mitigate those risks and promote better long-term outcomes. It is important that specific techniques with venous-only approach outlined in this article be followed to achieve optimal results.
Hitesh Agrawal; Benjamin Rush Waller; Sushitha Surendan; Shyam Sathanandam. New Patent Ductus Arteriosus Closure Devices and Techniques. Interventional Cardiology Clinics 2019, 8, 23 -32.
AMA StyleHitesh Agrawal, Benjamin Rush Waller, Sushitha Surendan, Shyam Sathanandam. New Patent Ductus Arteriosus Closure Devices and Techniques. Interventional Cardiology Clinics. 2019; 8 (1):23-32.
Chicago/Turabian StyleHitesh Agrawal; Benjamin Rush Waller; Sushitha Surendan; Shyam Sathanandam. 2019. "New Patent Ductus Arteriosus Closure Devices and Techniques." Interventional Cardiology Clinics 8, no. 1: 23-32.
Objective Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. Design The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. Setting A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Patients To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure‐related complications. Interventions It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Outcome measures This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. Results There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure‐related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. Conclusions It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.
Shyam Sathanandam; Hitesh Agrawal; Sandeep Chilakala; Jason Johnson; Kimberly Allen Rn; Christopher Knott-Craig; B. Rush Waller; Ranjit Philip. Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience. Congenital Heart Disease 2019, 14, 79 -84.
AMA StyleShyam Sathanandam, Hitesh Agrawal, Sandeep Chilakala, Jason Johnson, Kimberly Allen Rn, Christopher Knott-Craig, B. Rush Waller, Ranjit Philip. Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience. Congenital Heart Disease. 2019; 14 (1):79-84.
Chicago/Turabian StyleShyam Sathanandam; Hitesh Agrawal; Sandeep Chilakala; Jason Johnson; Kimberly Allen Rn; Christopher Knott-Craig; B. Rush Waller; Ranjit Philip. 2019. "Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience." Congenital Heart Disease 14, no. 1: 79-84.