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Introduction: Infants and children with congenital aortic stenosis and coarctation of the aorta can be treated by catheter intervention. There are several pharmacological and mechanical techniques described to overcome the balloon movement; none, however, have proved entirely satisfactory. An alternative method to achieve balloon stability is the use of rapid ventricular pacing. We describe our experience with titrating the pacing rate and the use of this technique., Methods: A retrospective review of database was performed, to identify patients who underwent transcatheter intervention with rapid ventricular pacing. Invasive systemic pressures were documented with a catheter in the aorta. Rapid ventricular pacing was initiated at the rate of 180 per minute and increased by increments of 20 per minute to a rate required to achieve a drop in systemic pressure by 50% and a drop in pulse pressure by 25%. The balloon was inflated only after the desired pacing rate was reached. Pacing was continued until the balloon was completely deflated., Results: Thirty patients were identified, 29 of whom had interventions with rapid ventricular pacing. Balloon valvuloplasty of aortic valve was performed on 25 patients while 4 patients had stenting for coarctation by this technique. The rate of ventricular pacing required ranged from 200 to 260 per minute with a median rate of 240. Balloon stability at the time of intervention was achieved in 27 patients., Conclusion: Rapid ventricular pacing is a safe and effective method to provide transient decrease in cardiac output at the time of transcatheter interventions to achieve balloon stability.

Coarctation of the aorta can be managed in different ways depending upon the age of presentation, anatomical details of the coarctation, the aortic arch anatomy, and whether the coarctation is native or a recurrence following surgery. In infants, surgery is the preferred treatment of choice, whereas in older children and adults, percutaneous procedures, such as balloon angioplasty or stent implantation, are becoming increasingly popular methods for treating coarctation. Various types of stents have been used and this paper specifically addresses the use of covered or graft Jomed stents in a small group of patients with coarctation.

We report two patients with small, muscular ventricular septal defects, both of whom had a potential risk of infective endocarditis and underwent transcatheter closure using a detachable Cook coil. We suggest that in selected patients this technique offers a simple and cost-effective alternative to surgery or double-disc device procedures.

The Amplatzer occluders are Nitinol-based devices that are preshaped for specific indications, primarily to close atrial septal defects, patent foramen ovale/fenestrations, or to occlude patent arterial ducts or one designed specifically for closure of ventricular septal defects. The flexible quality of the Nitinol together with the different designs of Amplatzer occluders make it possible for these plug devices to be used for conditions other than what they are designed for. This is particularly the case for fistulae where no specific devices are available and hence improvisation may be required. The established use of the Amplatzer occluder devices primarily for atrial septal defects and for patent arterial ducts provide the confidence to use them for alternative conditions where few or no alternatives are available or if surgery is the only option. This article describes the use of Amplatzer occluder devices for two unusual conditions, namely to occlude a pulmonary arteriovenous malformation and to close an aorto-left ventricular tunnel.