EXPLORATION OF THE LEFT HEART BY A RETROGRADE ARTERIAL APPROACH (SELDINGER'S METHOD) IN INFANTS AND CHILDREN

AbstractTransseptal puncture (TSP) is a standard procedure to obtain access to the left heart. However, data on TSP in infants and children particularly with congenital heart defects (CHD) is sparse. Safety and efficacy of TSP in infants and children < 18 years with normal cardiac anatomy and with CHD were assessed. 327 TSP were performed in a total of 300 individuals < 18 years from 10/2002 to 09/2018 in our tertiary pediatric referral center. Median age at TSP was 11.9 years (IQR 7.8–15; range: first day of life to 17.9 years). 13 subjects were < 1 year. Median body weight was 43.8 kg (IQR 26.9–60; range: 1.8–121 kg). CHD was present in 28/327 (8.6%) procedures. TSP could be successfully performed in 323/327 (98.8%) procedures and was abandoned in 4 procedures due to imminent or incurred complications. Major complications occurred in 4 patients. 3 of these 4 subjects were ≤ 1 year of age and required TSP for enlargement of a restrictive atrial septal defect in complex CHD. Two of these babies deceased within 48 h after TSP attempt. The third baby needed urgent surgery in the cath lab. Pericardial effusion requiring drainage was noted in the forth patient (> 1 year) who was discharged well later. Minor complications emerged in 5 patients. The youngest of these individuals (0.3 years, 5.8 kg) developed small pericardial effusion after anterograde ballon valvuloplasty for critical aortic stenosis. The remaining 4/5 patients developed small pericardial effusion after ablation of a left-sided accessory atrioventricular pathway (6.1–12.2 years, 15.6–34.0 kg). TSP for access to the left heart was safe and effective in children and adolescents > 1 year of age. However, TSP was a high-risk procedure in small infants with a restrictive interatrial septum with need for enlargement of interatrial communication.

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LEFT HEART CATHETERIZATION IN INFANTS AND CHILDREN

PEDIATRICS ◽

10.1542/peds.30.2.253 ◽

1962 ◽

Vol 30 (2) ◽

pp. 253-261

Author(s):

Edwin C. Brockenbrough ◽

Eugene Braunwald ◽

John Ross ◽

Andrew G. Morrow

Keyword(s):

Heart Disease ◽

Clinical Management ◽

Left Ventricular ◽

Infants And Children ◽

Heart Catheterization ◽

Pressure Measurements ◽

Left Heart ◽

Left Heart Catheterization ◽

Ventricular Puncture ◽

In Infants And Children

Experiences with left heart pressure measurements in 111 infants and children are reviewed. These studies were performed by means of transseptal left heart catheterization or anterior percutaneous left ventricular puncture. The only significant complication was the development of left pneumothorax in two patients following the latter procedure. The techniques are briefly described, and the importance of left heart catheterization in the clinical management of infants and children with heart disease is illustrated by means of selected clinical examples.

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Transseptal Left Heart Catheterization in Infants and Children

Catheterization and Cardiovascular Diagnosis ◽

10.1002/ccd.1978.4.2.213 ◽

1978 ◽

Vol 4 (2) ◽

pp. 213-223 ◽

Cited By ~ 28

Author(s):

Desmond F. Duff ◽

Charles E. Mullins

Keyword(s):

Infants And Children ◽

Heart Catheterization ◽

Left Heart ◽

Left Heart Catheterization ◽

In Infants And Children

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Understanding Limited Use of Amplification in Infants and Children Who Are Hard of Hearing

Perspectives on Hearing and Hearing Disorders in Childhood ◽

10.1044/hhdc25.1.15 ◽

2015 ◽

Vol 25 (1) ◽

pp. 15-23 ◽

Cited By ~ 1

Author(s):

Ryan W. McCreery ◽

Elizabeth A. Walker ◽

Meredith Spratford

Keyword(s):

Hard Of Hearing ◽

Hearing Aid ◽

Management Strategies ◽

Infants And Children ◽

Future Research ◽

Research Needs ◽

Case Examples ◽

Hearing Aid Use ◽

Wide Range ◽

In Infants And Children

The effectiveness of amplification for infants and children can be mediated by how much the child uses the device. Existing research suggests that establishing hearing aid use can be challenging. A wide range of factors can influence hearing aid use in children, including the child's age, degree of hearing loss, and socioeconomic status. Audiological interventions, including using validated prescriptive approaches and verification, performing on-going training and orientation, and communicating with caregivers about hearing aid use can also increase hearing aid use by infants and children. Case examples are used to highlight the factors that influence hearing aid use. Potential management strategies and future research needs are also discussed.

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