Radiation dose typical values per procedure complexity for transcatheter ventricular septal defect closure in pediatrics

This study aims to establish radiation dose typical values (TV) for ventricular septal defect (VSD) percutaneous closures based on patient-, device- and procedure-related characteristics. Clinical and exposure data were retrospectively reviewed for 92 consecutive pediatric patients with VSD in whom transcatheter closure attempt was undertaken between March 2016 and December 2019 at a single reference center. TV were derived as the median value of total air kerma-area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time and number of frames. Statistical analyses were conducted to investigate the exposure variability according to patient, device- and procedure-related characteristics. For (5–< 15 kg) patients, TV were 27 Gy · cm2 in term of PKA,T for venous vs. 9 Gy · cm2 for arterial approach. For (15–< 30 kg) patients, TV were 53 Gy · cm2 for muscular vs. 18 Gy · cm2 for perimembranous defects and 36 Gy · cm2 for AmplatzerTM vs. 14 Gy · cm2 for the LifetechTM device. Procedures conducted with the assistance of a fellow, venous approach, muscular VSD, AmplatzerTM devices, and procedural incidents increased the exposure levels significantly. The established TV provide benchmarks on patient exposure per procedure complexity and should help promote better patient radiation protection.

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Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012204 ◽

2016 ◽

Vol 9 (4) ◽

pp. 384-388 ◽

Cited By ~ 17

Author(s):

Tanja Schneider ◽

Emily Wyse ◽

Monica S Pearl

Keyword(s):

Radiation Dose ◽

Dose Reduction ◽

Cerebral Angiography ◽

Pediatric Patients ◽

Radiation Doses ◽

Digital Subtraction ◽

Air Kerma ◽

Reduction Strategies ◽

Technical Modifications ◽

Area Product

BackgroundOne goal of increasing awareness of radiation dose is to encourage personal and technical modifications in order to reduce the radiation exposure of patients and staff.ObjectiveTo analyze the radiation doses incurred during diagnostic cerebral angiography and the angiographic techniques practiced over a 4-year period, in order to demonstrate the effectiveness of implementing radiation dose reduction strategies.MethodsA retrospective review of the first 50 consecutive adult and pediatric patients undergoing diagnostic cerebral angiography each year from 2010 to 2013 was performed. Angiograms and procedure examination protocols were reviewed for patient age, gender, diagnosis, angiography techniques, fluoroscopy time, reference point air kerma (Ka,r in mGy), and kerma-area product (PKA in μGym2).ResultsFrom January 2010 to June 2013, a total of 231 diagnostic cerebral angiograms were reviewed (200 adults, 31 children). Adult patients were aged from 19 to 94 years and included 77 men and 123 women. Pediatric patients were aged from 2 to 18 years and comprised 11 boys and 20 girls. Median Ka,r and PKA significantly decreased from 2010 to 2013 in adults (1867 mGy; 21 231 µGym2 vs 653 mGy; 7860 µGym2) and children (644 mGy; 6495 µGym2 vs138 mGy; 1465 µGym2), (p<0.001).ConclusionsIncreased awareness and implementation of dose reduction strategies resulted in decreased radiation doses for diagnostic cerebral angiography both in adult and pediatric patients. The use of lower and variable digital subtraction angiography frame rates and tailored examinations contributed significantly to the reduced radiation doses observed during diagnostic cerebral angiography.

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Muscular ventricular septal defect closure with Gianturco coil at Soetomo hospital (a case report)

Paediatrica Indonesiana ◽

10.14238/pi50.2.2010.118-124 ◽

2010 ◽

Vol 50 (2) ◽

pp. 118

Author(s):

Alit Utamayasa ◽

Teddy Ontoseno ◽

Mahrus A Rahman ◽

Vinny Yoanna ◽

Rio Herdyanto

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Ductus Arteriosus ◽

Interventricular Septum ◽

Management Strategies ◽

Large Degree ◽

Ventricular Septal Defect Closure ◽

Skin Scar ◽

Muscular Vsd ◽

Gianturco Coils

Ventricular septal defect (VSD) is the mostcommon congenital heart disease (CHD)in children.1'2 It occurs in 1.5 to 3.5 of1,000 live births and constitutes 20% ofcongenital cardiac defects.1 The VSD may be small,medium or large and is classified based on its locationin the interventricular septum. There are four types ofVSD, i.e., perimembranous (80% ofVSDs), musculartype (5% to 20%) inlet or AV canal type (8%), andfinally, subpulmonary (5% to 7%).1-4 When multiplemuscular defects are seen, it is often referred to as"Swiss-cheese" type of VSD. 1•2The management strategies, which consist ofmedical, surgical and intervention techniques, depend toa large degree on the size of the VSD.1-4 Approximately40% of VSDs spontaneously and completely closed,with closure rates approaching 80-90% by age 2 years.2Indication ofVSD closure are symptoms of heart failure,left heart chambers overload and history of endocarditis.The surgical approach is considered gold standard butit is associated with morbidity and mortality, high cost,patient discomfort, sternostomy and skin scar.3 Since1988, percutaneous techniques have been conductedin order to reduce those drawbacks of surgery. Morerecently, percutaneous techniques and devices havebeen developed specifically for closure of muscularVSD (m VSD) and perimembranous VSD (pm VSD)using either the Rashkind double umbrella, the BardClamshell, the Button device, theAmplatzer septal, duct118 • Paediatr lrulones, Vol. 50, No. 2, March 2010or muscular VSD occluder, or the Gianturco coils.3AGianturco coils have been widely used to closeunwanted vascular communications and small- tomoderate- sized patent ductus arteriosus, withexcellent closure rates. In 1999, Latiff et al successfullyused this coil to close multiple muscular VSDs in a10-month old boy. Thus, percutaneuos closure ofVSDs using Gianturco coils is a feasible, reasonablealternative to surgery.5'6 We report a case of fouryear-old girl with muscular VSD who underwentcardiac catheterization and transcatheter closure withGianturo coil in Dr. Soetomo Hospital, Surabaya.

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Reducing radiation dose in paediatric interventional cardiac catheterisation

Cardiology in the Young ◽

10.1017/s1047951119001252 ◽

2019 ◽

Vol 29 (7) ◽

pp. 967-971

Author(s):

Jiarong Bai ◽

Feng Wang ◽

Haosheng Yang ◽

Ying Lu ◽

Lin Wu

Keyword(s):

Radiation Dose ◽

Ventricular Septal Defect ◽

Dose Group ◽

Low Dose ◽

Septal Defect ◽

Radiation Safety ◽

Cardiac Catheterisation ◽

Standard Group ◽

Defect Closure ◽

Ventricular Septal Defect Closure

AbstractObjective:Radiation exposure during paediatric cardiac catheterisation procedures should be minimised to “as low as reasonably achievable”. The aim of this study was to evaluate the effectiveness of a modified radiation safety protocol in reducing patient dose during paediatric interventional cardiac catheterisation.Methods:Radiation dose data were retrospectively extracted from January 2014 to December 2015 (Standard group) and prospectively collected from January 2016 to December 2017 (Low-dose group) after implementation of a modified radiation safety protocol. Both groups included five most common procedures: atrial septal defect closure, patent ductus arteriosus closure, perimembranous ventricular septal defect closure, pulmonary valvuloplasty, and supraventricular tachycardia ablation.Results:Median air Kerma was 48.4, 50.5, 29.75, 149, 218, and 12.9 mGy for atrial septal defect closure, pulmonary valvuloplasty, patent ductus arteriosus closure <20 kg, ventricular septal defect closure <20 kg, ventricular septal defect closure ≧20 kg, and supraventricular tachycardia ablation in Standard group, respectively, which significantly decreased to 18.75, 20.7, 11.5, 41.9, 117, and 3.3 mGy in Low-dose group (p < 0.05). This represents a reduction in dose to each patient between 46 and 74%. Among five procedural types in Low-dose group, dose of ventricular septal defect closure was the highest with median air Kerma of 62.5 mGy, dose area product of 364.7 μGy.m2, and dose area product per body weight of 21.5 μGy.m2/kg, respectively, along with the longest fluoroscopy time of 9.9 minutes.Conclusion:We provided a feasible radiation safety protocol with specific settings on a case-by-case basis. Increasing awareness and adequate training of a practical radiation dose reduction program are essential to improve radiation protection for children.

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Postinfarction ventricular septal defect closure with Amplatzer occluders

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(02)00812-6 ◽

2003 ◽

Vol 23 (3) ◽

pp. 323-327 ◽

Cited By ~ 47

Author(s):

M Szkutnik

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Defect Closure ◽

Ventricular Septal Defect Closure ◽

Postinfarction Ventricular Septal Defect

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Transcatheter closure of a ventricular septal defect resulting from knife stabbing using the Amplatzer muscular VSD occluder

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.20718 ◽

2006 ◽

Vol 68 (1) ◽

pp. 153-156 ◽

Cited By ~ 10

Author(s):

Colin Berry ◽

W. Stewart Hillis ◽

W. Brodie Knight

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Muscular Vsd

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Postinfarction posterobasal ventricular septal defect closure with a triple-layer patch

10.1510/mmcts.2021.011 ◽

2021 ◽

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Great Part ◽

Cardiac Apex ◽

Ventricular Septal Defect Closure ◽

Dacron Patch ◽

Basal Septum ◽

The Right ◽

Infarcted Tissue ◽

Anterior Septum

We present the case of a 65-year-old patient who developed a large posterobasal ventricular septal defect resulting from an extensive acute myocardial infarction involving the inferior and basal septum and wall. We repaired the interventricular lesion by verticalizing the cardiac apex to perform a left posterobasal ventriculotomy. We removed a great part of the residual infarcted tissue, leaving the residual scar in place. Our technique first involved creating a double-layer patch comprising heterologous pericardium and a non-collagen-impregnated Sauvage Dacron patch, fixed with single pledgeted U-stitches from the right side of the anterior septum; then we applied a third layer of heterologous pericardium on the left side of the septum in order to have only a pericardial surface in contact with blood on both ventricular sides. A running suture was used to complete the procedure from the middle to the posterior rim of the ventricular septal defect.

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