B P9 C83 Catheter-Based Treatment of Congenital Heart Disease in Adults Flashcards
Congenital valvular pulmonary stenosis accounts for ____% of all congenital heart disease.
5-10%
Before pulmonary valvuloplasty is performed, a complete right heart catheterization should be performed, followed by _____ to profile the right ventricular outflow tract (RVOT)
Right ventricular (RV) angiography
Angio- graphic measurements of the pulmonary annulus allows for the selection of the appropriately sized balloon, which is approximately _____% of the measured pulmonary annulus
120%
After dilation of the pulmonary valve, repeat angiography should be performed to rule out _____
Pulmonary regurgitation is best assessed on _____.
Vascular injury
Post-procedure echocardiography
The most common complication of pulmonary valvuloplasty is _____.
Pulmonary regurgitation (<10% with 2+ or greater pulmonary regurgitation), which is usually well tolerated
There are currently two available valve systems approved by the Food and Drug Administration (FDA) for transcatheter pulmonary valve replacement (TPVR):
Melody Transcatheter Pulmonary Valve (Medtronic, Inc., Minneapolis)
SAPIEN XT Pulmonic Valve (Edwards Lifesciences, Irvine, CA)
The Melody valve is composed of a valved segment of _____.
Bovine internal jugular vein that is fixed with glutaraldehyde and then sutured to a platinum-iridium stent frame
_____ is routinely performed prior to valve deployment to prevent stent fractures of the Melody valve frame.
RVOT stenting
There are currently two sizes of Melody valves available: _____ mm, with the delivery system available in three sizes: 18, 20, and 22 mm
20 and 22mm
The Edwards SAPIEN transcatheter heart valve (Irvine, CA) was originally designed for placement in the _____ position, but was found to have high success rates when placed in the pulmonary valve position,with the first successful pulmonary implantation in 2006.
Aortic
This device is composed of bovine pericardium of three equal-sized leaflets that are hand-sewn to a cobalt chromium balloon-expandable stent with a polyethylene terephthalate fabric cuff.
The Edwards SAPIEN transcatheter heart valve (Irvine, CA)
Additionally,the _____ has a new outer polyethylene terephthalate skirt which decreases the incidence of paravalvular leak.
SAPIEN S3
The SAPIEN valve comes in larger diameters of _____mm. These larger valve sizes allow for per- cutaneous intervention in patients with large native RVOTs, transannular patches, and large RV to PA conduits.
23, 26, and 29 mm
Valve selection is influenced by:
(1) Patient cohort (conduit versus transannular patch)
(2) Ease of use of the delivery system (stiffness and lack of flexibility of the delivery system for the Sapien)
(3) Operator experience/preference
Long-term complications of pulmonary valve systems include:
Stent frame fracture (Melody valve)
Valve dysfunction
Endocarditis
There are currently no stents approved by the FDA for use in pulmonary arteries; however, _____ have been used and have shown good radial strength, low profiles, and achievable diameters.
(1) Palmaz Genesis stents (Cordis, Milpitas, CA)
(2) EV3 family of stents (Covidien/ Medtronic, Minneapolis, MN)
Although CoA can present as an isolated lesion, it is also commonly found in genetic syndromes including:
Turner and Williams syndrome
The most common cardiovascular malformation associated with CoA is _____.
Bicuspid Aortic Valve (BAV)
_____ is now considered a mainstay in the management of adults with native CoA and recoarctation.
Transcatheter approach with stenting of the aorta
The covered _____ stent is approved by the FDA for use in coarctation, but other stents are often used off-label.The diameter of the implanted balloon should not be larger than that of the surrounding aorta or _____ times the narrowest dimension.
Cheatham pulmonary (CP) stent (NuMED, Inc., Hopkinton, NY)
3.5x
_____ are the third most common form of congenital heart disease.
Atrial septal defects (ASDs)
If the septal rim is deficient (<___ mm in contiguous zones), stable positioning will be more difficult to achieve and at times may not be possible.
<5mm
In contrast to the ASO, the _____ does not have a waist and is therefore not self-centering. Its primary benefit is that it can be placed in a small central defect and also covers numerous satellite defects
Cribriform Device
The _____ has been approved by the FDA for PFO closure in the context of cryptogenic stroke
Amplatzer PFO occluder
The ASO device is filled with interwoven _____ to facilitate platelet aggregation and endothelialization.
Dacron polyester fibers
Device sizing for the ASO should be based on the stop flow method of balloon sizing. In order to decrease the risk of device erosion, over inflation of the balloon should be avoided (not >___ the static echocardiographic dimension)
1.5x
Defects with a deficient _____ rim (<5 mm) are considered higher risk for an erosion.
Retroaortic Rim
The _____ clinical trial (evaluating PFO closure with the Amplazter PFO Occluder) showed that among adults with a history of a cryptogenic ischemic stroke, closure of a PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during extended follow-up.
RESPECT Trial
GORE redesigned its septal occluder system which is now marketed as the _____ .The new device consists of a five-wire nitinol frame, which adds radial strength and improves structural integrity, and it is covered with the same expanded polytetrafluoroethylene (ePTFE) membrane as the original Helex device
GORE Cardioform Septal Occluder (GSO) (W.L. Gore and Associates, Flagstaff,AZ)
Owing to its non–self-centering design, the GSO can only close defects up to __ mm in diameter.
18 mm
The principal modification from the original GSO is its anatomically adaptable “______” which expands to conform to the ASD size and shape, allowing different devices to treat a range of ASD diameters
“intra‐disc occluder”
Available sizes for GORE devices:
The available sizes are 27, 32, 37, 44, and 48 mm and are designed to treat defects ranging from 8 to 35 mm
The Gore _____ clinical study was a prospective single arm registry that evaluated the safety and efficacy of the GCA device. The study showed excellent technical success with 100% closure rate and low adverse event rates
ASSURED clinical study
The _____ study determined safety and efficacy of PFO closure with the GORE CARDIO- FORM Septal Occluder or GORE HELEX Septal Occluder plus antiplatelet medical management compared to antiplatelet medical management alone in patients with a PFO and history of cryptogenic stroke. The risk of subsequent ischemic stroke was lower among those assigned to PFO
closure combined with antiplatelet therapy than those assigned to anti-
platelet therapy alone
REDUCE study
The ____ ASD is a congenital abnormality that is caused by a deficiency of the common wall between the superior vena cava (SVC) and the right sided pulmonary veins
Superior sinus venosus ASD
_____ are the most common congenital heart defects and can range in size from tiny pinholes to near absence of the septum
Ventricular septal defects (VSDs)
VSDs can be an isolated finding or associated with other complex congenital heart diseases, primarily conotruncal defects (e.g.,_____).
ToF
DORV
ToGA
Catheter-based device closure of Perimembranous VSD remains controversial because of the associated risk of _____.
Heart block
Inlet VSDs are not amenable to transcatheter techniques because _____.
There is no circumferential tissue for secured placement of device
The _____ PDA. occluder device is made of a nitinol wire mesh packed with Dacron polyester fabric to facilitate platelet aggregation and endothelialization.
ADO-I
The second-generation ADO-II has symmetric retention skirts, which allow it to be placed in an antegrade or a retrograde fashion. The ADO-II is not packed with polyester fibers because the _____ than in ADO-I.
Nitinol wire weave is tighter
In patients with long, tubular ducts, a _____ may be the optimal occlusion device.
Vascular plug
The AVP-II has a wide assortment of sizes (_____ mm).The AVP-IV has fewer available sizes (_____ mm) and is slightly longer than AVP-II, but it offers an even lower profile, to easily navigate tortuous anatomy.
AVP-II: 3 to 22mm
AVP-IV: 4 to 8 mm
The ____ has a single nitinol wire coil, which can be wound in a funnel shape when it is advanced from the catheter. (PDA)
Nit-Occlud device (PFM Medical, Carlsbad, CA)
Device closure has become the first choice for secundum defect closure, when feasible, based on the morphology (includes stretched diameter </= 38 mm and sufficient rim of 5 mm except towards the aorta).
Retroartic (except ito sa rims) - 2mm minimum
IVC (most important)
SVC
Posterior rim
AV rim
