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Objectives. Patent ductus arteriosus (PDA) in elderly patients is an uncommon anomaly, and the duct itself is often calcified and fragile; therefore, transcatheter closure is more difficult. The aim is to analyse periprocedural and one-year follow-up results of transcatheter closure of PDA in such patients. Methods and results. Retrospective analysis of 33 elective patients aged ≥55 years (median 63; 56–85; 29 women), in whom PDA was closed percutaneously between 2002 and 2018 in two tertiary centres. All but three patients were symptomatic, with most in NYHA II (n = 14) and III (n = 11) class; pulmonary hypertension (n = 22), arterial hypertension (n = 22), duct calcifications (n = 17), atrial fibrillation (n = 15), significant mitral regurgitation (n = 5), and decompensated renal failure (n = 2) were observed. Different devices were applied depending on PDA morphology; nitinol wire mesh occluders with symmetrical articulating discs have been the most used in recent years (n = 11). Follow-up was conducted at an outpatient clinic (28/33 patients). The procedure was successful in all patients. There was one embolisation, followed by implantation of a larger device. No major complications were noted. A small residual shunt was present in echocardiography in one patient after one year. NYHA class improved in all but two patients (with multiple comorbidities). Conclusions. Transcatheter PDA closure in elderly patients is safe and efficient with a high complete closure rate and few complications. Amplatzer duct occluder type II is an attractive device in such patients.

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We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease.Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y.The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed.The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.

Coarctation of the aorta (CoA) is a very rare cause of secondary hypertension, accounting for 0.1% of cases. The coarctation can present at any age. Hypertension is the most common presenting symptom. All patients with newly diagnosed hypertension must have a physical examination with assessment of the brachial and femoral pulses and measurement of brachial and popliteal blood pressures. A thorough physical examination is a crucial first step in diagnosing aortic coarctation.

Background: Transcatheter patent ductus arteriosus (PDA) closure has become the first‑choice method of treatment in the majority of patients. However, device selection poses a challenge. Aims: This study aimed to analyze periprocedural and 1‑year outcomes of PDA transcatheter closure performed with different devices throughout a 25‑year time period in a single center. Methods: All 1036 patients who underwent transcatheter PDA closure between 1993 and 2020 were included in retrospective analysis. Various devices were used: the Rashkind device (RD; n = 25), coils (n = 469), nitinol duct occluders type I (DO I; n = 300), type II (n = 32), type II additional sizes (ADO II AS; n = 209), as well as off‑label devices: vascular plugs and atrial septal and muscular ventricular septal defect occluders (n = 17). Data on 24‑hour and 1‑year follow‑up were available for 100% and 78.9% of the study patients, respectively. Results: The procedure was successful in 98.6% of the study patients, with a major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of the patients treated with RD, 93.7% of those with coils, and 100% of those with duct occluders. There were no differences between Amplatzer DO I (n = 159) and its DO I copies manufactured in China (n = 141) with regard to success, efficacy, and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small‑to‑moderate PDA. Conclusions: Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1‑year follow‑up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.

Atrial septal defect is the most common congenital heart lesion in adults. Although atrial septal defect closure is recommended in those with right heart enlargement or paradoxical embolism, data informing such indications in adults are quite limited. This population has many unique characteristics and needs. In recent years, significant progress has been made with regard to diagnostic modalities that facilitate the diagnostic workup of these patients. However, the decision‑making process, especially in selected adult patients population (advanced age, various concomitant diseases, poor LV function [both systolic and diastolic], pulmonary hypertension, concomitant arrhythmias or multiple defects, or deficient rims) is still not easy. Available data are predominantly focused on imaging endpoints and short‑term morbidity and mortality rather than long‑‑term. The evidence base for outcomes with or without defect closure comes from various studies with different observation periods. Moreover, the clinical experience in diagnosing and treating that subgroup of patients is inhomogeneous between individual physicians (cardiologists, imaging specialists, operators) and between small and large experience centers. In the view of the above, the joint group of experts from the Association of Cardiovascular Interventions and the Grown‑Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications for treatment, methods of performing procedures, and tenets of postoperative care in Poland.

Pentalogy of Cantrell (PC) is an extremely rare multiple congenital anomaly syndrome, characterized by the presence of five major malformations: midline supraumbilical abdominal wall defect (which results in omphalocele), lower sternal defect, diaphragmatic pericardial defect, anterior diaphragmatic defect and various intracardiac malformations (mostly ventricular septal defect) [1]. Additionally, although not part of the classic PC, some severe cases have been associated with herniation of the heart through the diaphragmatic defect, resulting in ectopia cordis (EC) [2]. Such a diagnosis carries a disastrous prognosis without surgical correction or palliation [3]. Furthermore, miscellaneous intracardiac abnormalities even worsen the survival. Multiple chest interventions and complex anatomy impede their surgical treatment; therefore, the transcatheter approach may be the only possibility. According to our best knowledge, no percutaneous atrial septal defect (ASD) closure has been reported in a patient with PC.

Results of stent implantation (SI) of postsurgical recoarctation of the aorta (ReCoA) are not frequently published.This study sought to retrospectively evaluate results of SI in ReCoA in older children and adults.Twenty-eight SIs were performed on 26 ReCoA patients with a median age of 23 (10-65) years. Dependent upon availability, the following stents were applied: Palmaz, Cheatham Platinum (CP), Andrastents XL/XXL (AS), Covered CP (CVCP) stents, and self-expanding stents (Smart). Generally, high-pressure balloons were applied to dilate stents.The procedure was effective in 20/26 patients (77.7%). The mean peak systolic gradient reduced from 40.5 ± 18.7 mm Hg to 13.1 ± 12.1 mm Hg (p0.05), and the diameter of the stenosed segment increased from 7.5 ± 3.02 mm to 13.1 ± 3.32 mm (p0.05). In six cases (including a patient treated with a Smart stent) transaortic pressure gradient after SI remained20 mm Hg (stiff postsurgical lesion). For one patient (40-year-old male), an acute dissection of the aorta occurred during balloon predilatation. Immediate CVCP implantation resolved this problem. Two more CVCPs were used - one to close a small aortic aneurysm that appeared five years after a Palmaz SI and another to stabilise a broken CP bare metal stent. There were no deaths or aortic dissections during follow-up, and most patients were able to reduce or suspend their medication for systemic hypertension.Endovascular stenting of ReCoA in adults and adolescents appears to be an acceptable method of treatment in experienced hands. However, for some patients the presence of a stiff lesion can provoke suboptimal results. Considering the serious complications that can occur after SI, all patients should have regular follow-up (including an imaging study). Covered stents should always be available in the cathlab as a rescue device when implanting stents in coarctation of the aorta patients.

Aims The aim of this study was to present our experience with the AMPLATZER Duct Occluder II Additional Sizes (ADOIIAS) for the closure of different types of patent ductus arteriosus (PDA) in patients of various age groups. Methods and results A group of 103 patients, in whom the PDA (diameter below 3.5 mm) was closed using the ADOIIAS, was analysed. The median age of treated patients was 3.0 years (from 0.1 to 24 years), and 55 patients (53.4%) were older than three years. Ductal anatomy defined by angiography showed type A in 42 patients (40.8%), type C in six patients (5.8%), type D in 21 patients (20.5%), and type E in 34 patients (33.0%). In two cases, embolisation of the device occurred shortly after implantation. Both occluders were retrieved percutaneously. One death occurred in a neonate four days after ADOIIAS implantation (not related to the procedure: multi-organ failure). Total occlusion of PDA was confirmed in all patients the day after the procedure. No protrusion of the device into the aorta or pulmonary artery was observed in any patient during follow-up. Conclusions The use of the ADOIIAS is a good therapeutic option for the treatment of selected PDA. The implant may be successfully substituted for coil implantation in all age groups.

Background and aim: Patent foramen ovale (PFO) may result in a cerebrovascular event — a presumed paradoxical embolism (PE). However, the presence of this phenomenon among paediatric patients was rarely evaluated. Transcatheter PFO closure was considered to be a method of treatment in such patients. Methods: For evaluation clinical data and long-term outcome, we reviewed records of patients below 18 years of age, with history of cerebrovascular event related to PE, who underwent procedure of percutaneous PFO closure in years 1999–2014 in our department. Results: Among 230 patients with cerebrovascular events who had PFO closed percutaneously, seven children (aged 12–16 years, five male) were selected. Indications for closure were cryptogenic stroke in two patients and transient ischaemic attack (TIA) in five patients. Diagnosis of PFO was established by transthoracic echocardiography, with right-to-left shunt (RLS) through PFO confirmed by transoesophageal echocardiography. Contrast transcranial Doppler (c-TCD) was performed preprocedurally in four patients, revealing significant RLS. For percutaneous closure of PFO different occluders (Starflex, Amplatzer PFO devices, Cardio-O-Fix) were used. Closure was successfully completed in all patients and no procedure-related complications were observed. Postprocedural c-TCD six months after closure revealed no significant RLS. During follow-up (3 to 10 years) one patient had an episode of recurrent TIA; however, in this patient paroxysmal atrial fibrillation was found during the follow-up period. Conclusions: Cerebral embolism due to PFO is uncommon in children. Transcatheter PFO closure in this group of patients is a safe and effective procedure. C-TCD is plausible technique for detection RLS and monitoring PFO closure efficacy in this group of patients.

Background: Atrial septal defect (ASD) type 2, according to current standards, is closed percutaneously usually after the child has reached the age of four to five years. There are limited data regarding such treatment in younger infants. Aim: We sought to evaluate the feasibility, safety, and efficacy of percutaneous ASD closure in children under three years of age. Methods: The research group consisted of 157 children less than three years old with haemodynamically significant ASD, who underwent effective transcatheter ASD closure in a single tertiary centre between 1999 and 2014. The mean procedural age of the treated children was 2.2 years and mean weight was 12.5 kg. In all cases nitinol wire mesh devices were applied (mostly Amplatzer Septal Occluders). ASD was closed using standard technique (except a few cases wherein the left disc of the implant was inserted initially into the right pulmonary vein to prevent oblique position of the device). Procedure-related complications were divided into major and minor ones. Results: Atrial septal defect was closed in 149 children: 97 with a single ASD and 52 with double/multiple ASD. The procedure was abandoned in eight patients (three with single and five with double/multiple ASD). No death or implant embolisation occurred during the procedure or follow-up, and there was one case of major postprocedural complications. Normalisation of the right ventricular diameter occurred in all patients during one-year follow-up. In the majority of children acceleration of physical development and resolution of accompanying morbidity were observed in follow-up. Conclusions: Percutaneous ASD closure can be performed safely in children under three years of age with low risk of peri- or postprocedural complications.

Introduction : Balloon angioplasty (BAP) and aortic or pulmonary balloon valvuloplasty (BAV, BPV) are well-established treatment options in congenital heart defects. Recently, significant technological progress has been made and new catheters have been implemented in clinical practice. Aim: To analyze the results of BAP, BAV and BPV with the new balloon catheter Valver and its second generation Valver II, which the company Balton (Poland) launched and developed. These catheters have not been clinically evaluated yet. Material and methods: We performed 64 interventions with Valver I and Valver II. With Valver I the following procedures were performed: 17 BPV (including 9 in tetralogy of Fallot – TOF), 10 BAV and 27 BAP in coarctations of the aorta (CoA) – including 9 native and 18 after surgery. With Valver II ten interventions were done – 3 BPV, 2 pulmonary supravalvular BAP (after switch operations), 2 BAP of recoarctations and 3 other BAP. Age of the patients ranged from a few days to 40 years. Results: All procedures were completed successfully, without rupture of any balloon catheters. The pressure gradient drop was statistically significant in all groups: BPV in isolated pulmonary valvular stenosis 28.1 mm Hg (mean), BPV in TOF 18.7 mm Hg, BAV 32.8 mm Hg, BAP in native CoA 15.4 mm Hg and in recoarctations 18.6 mm Hg. In 3 cases during rapid deflation of Valver I, wrinkles of the balloons made it impossible to insert the whole balloon into the vascular sheath (all were removed surgically from the groin). No such complication occured with Valver II. Conclusions : Valver balloon catheters are an effective treatment modality in different valvular and vascular stenoses.

In recent years, we have been observing an increased proportion of atopic diseases in children after solid organ transplantation. The pathogenesis of post-transplantation allergy is not completely understood and probably involves several factors, including immunosuppressive therapy. In this paper we present a case of 3-year old boy, after orthotopic heart transplantation at 6 months of age, with symptoms of food allergy associated with atopic dermatitis and changes in the orofacial area. The mentioned symptoms and elevated levels of total and specific IgE occurred with a year of transplant. Because of failure to achieve remission after typical allergy therapy we suspected that the reason of allergy in this case can be immunosuppressive therapy.

Background— Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous disease and, although increasingly recognized in clinical practice, there is a lack of widely accepted diagnostic criteria. We sought to identify novel genetic causes of LVNC and describe genotype–phenotype correlations. Methods and Results— A total of 190 patients from 174 families with left ventricular hypertrabeculation (LVHT) or LVNC were referred for cardiac magnetic resonance and whole-exome sequencing. A total of 425 control individuals were included to identify variants of interest (VOIs). We found an excess of 138 VOIs in 102 (59%) unrelated patients in 54 previously identified LVNC or other known cardiomyopathy genes. VOIs were found in 68 of 90 probands with LVNC and 34 of 84 probands with LVHT (76% and 40%, respectively; P P P =0.01). The presence of sarcomeric gene mutations was associated with increased occurrence of late gadolinium enhancement ( P =0.004). Conclusions— LVHT and LVNC likely represent a continuum of genotypic disease with differences in severity and variable phenotype explained, in part, by the number of VOIs and whether mutations are present in sarcomeric or nonsarcomeric genes. Presence of VOIs is common in patients with LVHT. Our findings expand the current clinical and genetic diagnostic approaches for patients with LVHT and LVNC.

Introduction : Stent implantation is an effective therapy for aortic coarctation (CoA) in adolescents and adults. Aim : To present a unique group of patients with native coarctation of the aorta older than or equal to 46 years treated with bare metal or covered stents. Material and methods : Since 2002 we have performed stent implantations by applying bare metal stents or covered stents using femoral access in 24 patients aged 46 and older. Results : We used the Mullins technique in all cases, implanting different stents: Palmaz, Cheatham-Platinum (CP), covered CP or Andrastents XL/XXL. Twenty-one procedures were elective and 3 were urgent. Eighteen bare metal stents (2 stents in one patient) and 7 covered stents were used. All procedures were effective (CoA gradient reduced < 20 mm Hg), despite 2 migrations of bare metal stents. Mean gradient was reduced from 50.6 ±15.3 to 6.8 ±6.5 mm Hg (p < 0.001) and mean lumen diameter of stenosed aorta increased from 5.5 ±2.5 to 14.9 ±5.2 mm (p < 0.001). One special case is discussed – a 49-year-old man with end staged heart failure and severe CoA, who underwent a rescue procedure with a bare metal stent. One serious complication – stroke of the central nervous system – was observed in a 53-year-old woman during covered stent implantation (symptoms resolved during rehabilitation process). Conclusions : Stent implantation of native coarctation of the aorta is also a safe procedure in the eldest patients and is associated with persistent relief of aortic obstruction.

Ventricular septal defects closure (VSD) depending on the anatomy and clinical setting can be performed surgically or by a hybrid and transcatheter approach. Two cases of children with VSD will be presented. Patients' defects were closed with various types of occluders made of nitinol wire mesh occluder, patent ductus arteriosus (PDA) type. The first case was a 2.5-year-old boy after cardiosurgical correction of tetralogy of Fallot (TOF). After the procedure, a significant haemodynamic residual VSD was observed, which was not successfully closed during the subsequent reoperation. Despite pharmacological treatment, symptoms of heart failure were observed in this patient. In echocardiographic images the residual VSD was presented as a tunnel-like dissection of the ventricular septum (length 6 mm and diameter 3.4 mm). The defect was closed via arterial access with an Amplatzer Duct Occluder II (ADO II). The procedure was successfully performed without any medical complications. In this child, a significant shunt reduction and a noticeable improvement in the patient's clinical status and diminished symptoms of heart failure were noticed. The second patient was a 4-year-old girl suffering from a multi-perforated perimembranous VSD accompanied by a ventricular septal defect with aneurysm. The defect was closed by a venous approach with a PDA Cardio-O-Fix occluder (very similar to ADO I). No short-term or long-term complications were visible during or after the procedure. Only a mild residual shunt through the VSD was observed 6 months afterwards. Transcatheter VSD closure with a proper morphology, with occluders of type Amplatzer Duct Occluder ADO I or ADO II, constitutes a safe and effective therapeutic alternative.

Coronary artery fistulas (CAF) are the most common congenital anomaly of this vessel. We present the case of a 26-year-old man with two coexisting congenital cardiac defects: patent ductus arteriosus (PDA) and CAF. The patient 3 months earlier had the transcatheter PDA closed (type A, diameter 4 mm) with a 10/8 mm PDA nitinol wire mesh occluder. After the procedure he continued to have symptoms of fatigue and continuous murmur in the precordial region persisted. In angio-CT a large coronary fistula from the circumflex coronary artery with suspicion of multiple orifices to the right atrium was found. An arteriovenous wire loop was created (guidewire introduced from the aorta through the CAF was snared using a lasso catheter in the superior vena cava and exteriorized through the right femoral vein). Retrogradely an 8 F long sheath and delivery system was introduced to the end of the fistula and a 12/10 mm Cardio-O-Fix PDA occluder (Starway Comp, China, Beijing) was implanted, closing one orifice of the CAF. Another leak (orifice of CAF – 3.5 mm diameter) was closed using a similar technique with a 10/8 mm PDA Cardio-O-Fix device. Complete closure of the coronary artery fistula and disappearance of the heart murmur were observed after the procedure. The patient was discharged home 4 days later on acetylsalicylic acid 150 mg/day. During 6 months of follow-up he was doing well without any complaints or pathological symptoms. In control angio-CT performed 3 months after the procedure complete closure of the CAF was confirmed.

Background: Although currently used devices for interventional closure of patent foramen ovale (PFO) are widely used due to the minimally invasive nature of this technique and high success rate, there is still a need to look for new materials and designs in order to improve the treatment outcomes. Aim: To evaluate the safety, biocompatibility, temporal healing patterns, and coverage dynamics of the new Polish PFO occluder (Balton, Warsaw, Poland) in a swine model — an observation that may assist the decision with regard to its first-in-human use and duration of anticoagulation therapy. Methods: In total, 12 pigs were scheduled for 28-day (n = 6) and 90-day follow-up (n = 6). In each animal, using a standard femoral venous approach, one PFO occluder was implanted and subsequently, in order to verify device position stability, the Minnesota manoeuvre was performed. At follow-up, all devices underwent a comprehensive evaluation with the use of high-resolution radiography (Faxitron MX-20 system), scanning electron microscopy (SEM), and standard histopathological techniques. Results: All PFO occluders were implanted successfully with no complications. The Faxitron revealed that all nitinol portions of the frame appeared intact and breaks were not detected at both studied time points. Overall, the device appeared to be well deployed in the atrial septum. At 28 days the average neointimal coverage of the right side of the PFO occluder by SEM was 92%; while in contrast the left side had less coverage, at 63%. At 90 days, the coverage of the right side of the occluder was 96.8%, while the left side of the PFO occluder improved and had similar coverage of 93.3%. By histology the endothelialisation process was virtually complete at 90 days. At the early time-point the overall inflammatory infiltrate was moderate and subsequently it diminished and was only mild or occasionally moderate at 90-day follow-up. At both time points the inflammatory reaction was limited to the neointimal tissue surrounding the device. Conclusions: Our study confirmed safety and good overall biocompatibility of the new Polish PFO occluder, which is comparable to other devices available on the market — an observation that supports the decision with regard to its first-in-human application. Neoendothelialisation was virtually completed at 90 days, suggesting that similarly to other widely used devices a minimum of three to six months of anticoagulation therapy should be recommended.

Background: Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement. Methods: Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%). Results: All procedures were successful — 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation — with only 1 significant valve stenosis). Conclusions: Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients.

Background: The treatment of advanced heart failure (HF) in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital aetiology. The treatment schedules for paediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the paediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance of surviving the period of waiting for a heart donor. Aim: The aim of the study was to analyse the outcomes of circulatory support in Poland and to assess the advisability of this method for treatment of children with severe HF. Methods: This treatment of paediatric patients is currently used in three Polish centres. From December 28, 2009 to August 1, 2015, 27 implantations of BerlinHeart EXCOR® mechanical circulatory support system were performed in children aged from one month to 16 years (10 patients below one year of age; 37%). Left ventricular assist devices were implanted to 21 patients, whereas the remaining children received biventricular support. The most common reason for using this method was HF developed in the course of cardiomyopathy. In one case, HF after Fontan operation was the indication. Results: The duration of the circulatory support period ranged from six to 1215 days. It was followed by successful heart transplantations in 10 (37%) patients, in five (18.1%) it resulted in regeneration of the heart, enabling explantation of the device, whereas three children are still waiting for transplantations. Nine (33%) children died during the therapy because of thromboembolic complications. Conclusions: As follows from our data, circulatory support utilising the BerlinHeart EXCOR® system is an effective and promising method used as a bridge to cardiac transplantation, or for regeneration of the myocardium in paediatric patients. In the group of the youngest and the most difficult patients, the method requires close cooperation of the medical and nursing personnel.

Patent ductus arteriosus (PDA) is one of the most prevalent congenital heart diseases. Transcatheter closure of PDA is the treatment method of choice. In spite of recent advances in transcatheter management, the occlusion of certain anatomical types of PDA remains a challenge. The aim of the study was to report novel use of the Amplatzer Vascular Plug type II (AVPII) for closure of large elongated type of PDA (type E according to Krichenko classification) in a 19-year-old man. In clinical examination a soft continuous murmur was heard in the 2-3 left intercostal space. Echocardiography confirmed left to right shunt through the PDA. Left ventricle and left atrium were at the upper limit for body weight. In angiography the duct was 20 mm long, 7 mm wide with 3 mm narrowing at the pulmonary end. For the procedure we applied a 12 mm AVPII. The AVPII is a self-expanding, nitinol wire mesh occluder dedicated for arterial and venous occlusion in the peripheral circulation. It was delivered through a 6 F catheter retrogradely. The distal disc and medial part of the AVPII were opened inside the duct, and the proximal disc in the pulmonary artery. Complete closure of the PDA was confirmed in angiography. No complications during the procedure or 3-month follow-up were observed. Application of the AVPII is a safe and effective method of treatment for adult patients with elongated type of PDA.

This paper presents the case of a young girl with idiopathic pulmonary hypertension, who developed signs of severe heart failure within a short period of time. Pharmacotherapy with sildenafil and bosentan (among other drugs) was ineffective. Heart catheterization revealed suprasystemic pressure in the pulmonary artery. At the age of 7.5 years, the patient underwent a surgical Potts shunt (namely, a direct side-by-side anastomosis from the left pulmonary artery to the descending aorta). The procedure resulted in a significant improvement of the clinical, echocardiographic, and biochemical parameters, which persists after one and a half years of follow-up. After the surgery, pharmacotherapy with bosentan was gradually discontinued.

Background: The purpose of this study was to assess the effectiveness of cardiac resynchronization therapy (CRT) in terms of outflow tract gradient reduction and functional improvement in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) requiring implantable cardioverter-defibrillator (ICD) implantation. Methods: Eleven consecutive symptomatic HOCM patients with a significant (≥40 mmHg) gradient and indications for ICD, but without indications for resynchronization, underwent CRT-D implantation. Nine of them (four female, median age of 50 years) in whom the procedure succeeded were screened for New York Heart Association (NYHA) class, outflow gradient, mechanical dyssynchrony, QRS-width change, and 6-minute walking distance (6MWD) and peak oxygen consumption (VO2peak) improvement after 6 months and remotely. Results: After 6 months of pacing, NYHA class decreased (median 1 vs 2, respectively); peak (33 vs 84 mmHg) and mean (13 vs 38 mmHg) outflow tract gradients were reduced; and QRS width (143 vs 105 ms), intraventricular dyssynchrony (35 vs 55 ms), and VO2peak (19.5 vs 14.2 mL/kg/min) increased significantly (all P 50% and reached

We present two procedures of transcatheter closure: that of an aorto-pulmonary window in a 12-month-old infant with a body weight of 7 kilograms, and that of ruptured sinus of Valsalva aneurysm into the right atrium in an adult patient. In the first case, we applied the muscular ventricular septal defect Cardio-O-Fix, while in the other we applied the patent ductus arteriosus Cardio-O-Fix occluder. The procedures were successful in both patients, and we achieved complete closure of the unwanted shunts.

We report the transcatheter closure of six ruptured sinus of Valsalva aneurysms (RSVAs) in five patients aged 18-51 years. The RSVA extended into the right atrium in three patients, into the right ventricular outflow tract in one, and into the pulmonary artery in one. In all patients, the RSVA was entered from the aorta, an arteriovenous loop was created, and the Amplatzer occluders were implanted using a venous approach. Six procedures were performed in five patients. Five Amplatzer duct occluders and one Amplatzer atrial septal occluder were implanted. In one patient who had a left RSVA after deployment of an Amplatzer duct occluder, ST-segment depression was observed on the ECG and the procedure was abandoned. In the other four patients, complete closure of the RSVA was confirmed by color Doppler echocardiography. No complications were observed during 9-19 months of follow-up. Percutaneous closure of an RSVA is feasible and can be used as an alternative to surgery.

Presentamos el cierre transcateter de 6 aneurismas del seno de Valsalva con rotura (ASVR) en 5 pacientes de 18-51 anos. El ASVR estaba abierto a la auricula derecha en 3 pacientes, al tracto de salida ventricular derecho en uno y a la arteria pulmonar en otro. En todos los pacientes, se atraveso el ASVR desde el lado aortico, se creo un bucle arteriovenoso y se implantaron oclusores Amplatzer con un abordaje venoso. Se realizaron seis intervenciones en 5 pacientes. Se implantaron 5 dispositivos Amplatzer Duct Occluders (ADO) y un Amplatzer Atrial Septal Occluder (ASO). En 1 paciente con un ASVR izquierdo tras el despliegue de un ADO, aparecio una depresion del ST en el ECG y se abandono la operacion. El cierre completo del ASVR se confirmo mediante Doppler color en los otros 4 pacientes. No se observaron complicaciones durante el seguimiento de 9-19 meses. El cierre percutaneo del ASVR es una intervencion factible que puede sustituir al tratamiento quirurgico.

Transcatheter closure of atrial septal defects (ASDs) was performed mainly in children and adolescents. Information about outcome and complications in adults was limited. From November 1997 to November 2005, percutaneous closure of ASDs using the Amplatzer septal occluder was attempted in 650 consecutive adult patients. Median patient age was 45.8 +/- 16.2 years (range 18 to 90), mean systolic artery pressure was 33.3 +/- 10.6 mm Hg (range 11 to 85), and mean pulmonary and systemic blood flow (Qp/Qs) ratio was 1.9 +/- 0.7 (range 0.8 to 6.6). Mean stretched diameter of the ASD was 21.2 +/- 5.1 mm (range 3.1 to 43). Seventy-eight patients (12%) had multiple defects. Of 572 patients with a single ASD, device implantation was successful in 563 patients (98%). During follow-up, complete closure could be achieved in 96% of patients with a single ASD and 71% of patients with multiple defects. Mean systolic artery pressure decreased to 28.3 +/- 10.1 mm Hg and mean Qp/Qs ratio decreased to 1 +/- 0.3. The 3 complications that occurred during the procedure were device embolization (2 patients; 0.3%) and transient ST depression (1 patient; 0.2%). The most common complication immediately after the procedure and during follow-up was new-onset atrial fibrillation (28 patients; 4.3%). Electrical cardioversion was successfully in most. Complications requiring emergency or elective surgery occurred in 6 patients (0.9%; hemopericardium, 2 patients, 0.3%; device embolization, 3 patients, 0.5%, and pericardial tamponade, 1 patient, 0.2%). In conclusion, closure of ASDs using the Amplatzer septal occluder in adults was efficient and safe, with excellent long-term success rates. Serious complications were rare.

Increased prevalence of patent ductus arteriosus (PDA) at high altitude (HA) is a known occurrence. Transcatheter treatment of patients with PDA living at a HA is assessed in this study. Thirteen consecutive patients (all habitants of La Paz, Bolivia) underwent transcatheter closure of PDA. The minimal diameter of PDA was 5.8 (1.5-11) mm and the mean pulmonary artery pressure was 37 (7-80) mm Hg. In 12 patients, the Amplatzer Duct Occluder (ADO) was used; in one child with PDA with a 1.5-mm diameter, a detachable coil was implanted. All procedures, except for one, were completed successfully. The ADO (diameter: 12/10 mm) implantation failed in one child with pulmonary hypertension because the device could not be properly secured in position in a 6-mm PDA. Subsequent surgery was performed without any complications. No residual shunt after 24 h was observed in any case after treatment. No complications were encountered during the procedure and follow-up of 1.5 (from 0.1 to 2.8) years. PDA in native residents of high land have different physiopathologies and anatomies. ADO appears to be a suitable device for transcatheter occlusion for most such patients. Interventional cardiology in countries with residents at high altitudes can be helpful in addressing this issue.

Background: Transcatheter closure of a perimembranous ventricular septal defect (PmVSD) is usually performed with an asymmetric Amplatzer occluder, which is not an ideal device. Experience with the use of the Amplatzer muscular ventricular septal defect occluder (MVSO) to close selected PmVSDs is presented. Setting: Two tertiary referral centres for paediatric cardiology in two countries. Objective: To look at the safety and efficacy of the application of the MVSO in patients with appropriate PmVSD anatomy. Patients and intervention: The procedure was performed in 10 patients aged 3.2–40 (mean 12.5) years. All had a PmVSD with a mean diameter of 5.4 (range 4–11) mm, with an extension towards the muscular septum. The mean distance of the defect from the aortic valve was 5.4 (range 4–6) mm. In all but one patient, the MVSO was introduced in routine antegrade transvenous fashion (4-mm device in one patient, 6-mm device in five, 8 mm in two, 10 mm in one, and 12 mm in one). In one patient, the device was deployed by retrograde implantation. Results: All procedures except one were performed without complications, and complete closure of the VSD was achieved. One patient with a residual shunt developed haemolysis, which resolved over 10 days. In three patients, trivial, non-progressive tricuspid regurgitation appeared after the procedure. No other complications were observed over 1.7 (range 0.2–3.5) years of follow-up. Conclusion: Application of the MVSO for closure of selected PmVSDs seems to be a safe and effective treatment option.

We carried out transcatheter procedures to close postinfarction ventricular septal defects (PIVSDs) in 19 patients: two had recanalization after surgical closure, and 17 had a primary PIVSD. In three of the latter patients, who had acute PIVSDs, the procedure was carried out in the first 3 weeks after infarction; in the 13 patients with subacute PIVSD, it was carried out 3.5-12 weeks after infarction. There was another procedure in one patient with chronic PIVSD. In total, 22 procedures were completed: 17 using an Amplatzer atrial septal occluder, two using an Amplatzer postinfarction ventricular septal defect occluder, and two using an Amplatzer muscular ventricular septal defect occluder. The procedure was successful in 14 patients: in 11 with subacute PIVSD, one with chronic PIVSD, and two with postsurgical PIVSD. Transcatheter closure of PIVSDs using an Amplatzer atrial septal occluder is probably the treatment of choice in patients undergoing surgery more than 3.5 weeks after myocardial infarction and in those with recanalization after previous surgical closure.

A 19-year-old woman with atrial septal defect treated percutaneously with an Amplatzer Septal Occluder 24 months earlier, who presented with a history of bacterial meningitis, was admitted with a diagnosis of endocarditis. After 6 weeks of treatment with antibiotics, the incompletely endothelialised occluder was surgically removed. The present report illustrates the need for long-term follow-up of patients who have received nitinol wire mesh occluders.

AIMS The aim of this study is to present our experience with a new type of extra-large stent, namely the AndraStent XL/XXL. METHODS AND RESULTS AndraStents were implanted in 46 patients, 38 with native coarctation of the aorta (CoA) and eight with recurrent coarctation of the aorta following previous surgery (ReCoA). All patients had arterial hypertension in the upper limbs, absent or weak femoral pulses, and continuous flow in the abdominal aorta on Doppler examination. The median age of patients was 25 years (range from nine to 65). The stents (cobalt-chromium with semi-open cell design) were manually mounted on balloon catheters and delivered through 10 to 14 Fr Mullins sheaths using a conventional femoral approach. All procedures were successful (no stent migration, proper expansion, no aorta dissection/rupture, major bleeding or major vessel injury). The systolic gradient across the aorta decreased from 40.6 mmHg before the procedure to 11.6 mmHg after the procedure (p

A singularly interesting medical event was held under the banner ‘Fistulas from A to Z’ on 8-10 January 2014 in Ho Chi Minh City (Saigon, Vietnam). The congress concerned the advancement of interventions for congenital and structural heart defects (CHD), particularly the problematic issue of vascular fistulas. I was invited as a lecturer and proctor. My presentation referred to the application of new balloon catheters (Valver) for valvuloplasty and angioplasty. Our experience concerning these Polish catheters was satisfactory and it had been discussed before [1]. More than 300 people gathered to attend the conference as well as the illustrious group of faculties representing all continents. On the first day (8 January), the advancement of the main techniques, currently applied to interventions for the treatment of CHD, was discussed. One of the most significant lectures were delivered by Dr Miro from Canada (“PDA closure in small babies”) and Dr Amin (US) concerning interventions for the ASD closure. The latter one referred to the meaning of the deficient rim and its role in avoiding serious complications that may occur following surgery, such as atrial or aortic wall erosion. According to the conclusion of that lecture, patients who underwent the transcatheter ASD closure, should remain under lifelong observation. At least once a year, ECHO should be conducted (in order to exclude the presence of the pericardial fluid) as well as ECG (for exclusion of the iatrogenic arrhythmia). Dr. Carminati (Italy) talked about the significance of the patent foramen ovale closure (PFO) in patients with the cryptogenic stroke, regardless of the negative results of randomized “Closure” trials (concerning StarFlex implant) and “Respect” trial (realized with Amplatzer PFO Occluder). He presented his doubts about those results and added that it will be an unresolved issue for a long time. Dr. Le, a Vietnamese working in Germany, creator of Nit-Occlud Le VSD implant, a good spirit of the conference, declaimed about the possibility of percutaneous closure of doubly committed VSD (also with the usage of his implant). Dr. Celebi (Turkey) discussed his experience with percutaneous closures of VSD (mainly perimembranous) with the application of different implants. Depending on the morphology of the defect, he used various coils and implants made of nitinol wire mesh (type PDA, muscular VSD and others – American and Chinese production). In his material, no patient had either a heart rhythm disorder and cardiac conduction disease in the follow-up, or aortic valve regurgitation and tricuspid insufficiency, which may cause complications in such interventions. During the congress, a new pulmonary valve in the stent (Venus P Valve System), produced by Liftech, was presented. This very interesting product can be used in the case of a wider right ventricular outflow tract (RVOT) – also after correction of the Tetralogy of Fallot (TOF) with annular dilatation with patch, which is the most frequent in Poland. The implantation of the pulmonary valve is an outpatient procedure, whose main problem is the shortage of patients, who fully meet the criteria for the currently used “Melody” (maximum diameter 24 mm) and “Edwards” valves (maximum diameter 26 mm). Consultants of the venous valve are high quality experts such as Dr. Qureshi (UK) and Dr. Hijazi (US). With that valve, 10 procedures thus far have been performed in patients after surgical correction of TOF. For the first time in this congress, participants were directly acquainted with the method of implantation and valve's structure. It is made from pig pericardium and bound on a self-expanding nitinol stent, which does not require pre-stenting (as opposed to “Melody” and “Edwards” valves). Radial strength for this stent does not seem to be high, which indicates its potential application only in cases of dominant pulmonary regurgitation (frequent clinical problem). A number of procedures were performed live during the conference, usually by foreign experts. Within 3 days, 33 interventions, of any grade, were conducted. Procedures ranged from balloon pulmonary valvuloplasty (BPV) and balloon aortic valvuloplasty (BAV) to ASD closure, VSD closure and PDA closure, with different occluders for stent implantation in aortic coarctation, pulmonary artery and PDA, left atrial appendage closure etc. I was participating in effective BPV, performed in an infant (body mass 9.4 kg) with balloon catheter Valver produced by Balton Ltd. (operators: Dr. Jou-Kou Wang – President of the Taiwan Society of Pediatric Cardiology and Dr. Do Nguyen Tin – Head of Hemodynamics in Children's Hospital No. 1 in Saigon, performing over 1000 interventions in CHD/year). The time of scopy during the procedure was 1.5 min and pressure of gradient decreased from 56 mmHg to 11 mmHg (Fig. 1A-D). Both operators were impressed with rapid inflation and deflation during BPV. Participants were probably mostly interested in live procedures of vascular fistulas closure (altogether, 12 coronary fistula closures, 1 vein hepatic vein fistula, 1 pulmonary arteriovenous fistula and 1 rupture of sinus of Valsalva aneurysm [with various implants]). Such a large number of cases concerning vascular fistulas was spectacular. In our material, there are 3 cases of coronary fistulas, including 2 published cases [2, 3] and 5 cases of pulmonary arteriovenous fistulas [4], 2 vein hepatic vein fistulas in patients after Fontan procedure (one published [5]) and 13 cases of ruptures of sinus of Valsalva aneurysm [6]. A debate over indications for intervention in particular cases as well as professional lectures by experts (Dr. Qureshi, Dr. Amin, Dr. Balavi [India], Dr Miro and others) gave a unique chance to learn about a vast range of therapeutic options, indications for treatment, potential risk related with the procedures and complications. Dr. Qureshi presented his rich experience presenting also the case of Professor Sabiniewicz, which was performed in Gdansk. I will never forget the coronary fistula closure performed by Dr. Sievert (Germany), which resulted in embolization of implanted Amplatzer Duct Occluder AS. It was removed percutaneously and Amplatzer Muscular VSD Occluder (MVSDO by Liftech) was successfully implanted. As far as asymptomatic coronary fistulas are concerned, therapy should not be initiated. When it comes to symptomatic fistulas with tabular morphology, implants type plug I, II, IV or Amplatzer Duct Occluder (ADO) type II are applied, and in the case of the existing stenosis, type ADO I or MVSDO. The necessity of taking aspirin after the procedure is crucial. In the case of narrow fistulas, the patient should take 3-5 mg/kg body weight for at least 6 months. One may also take aspirin and clopidogrel in the case of fistulas with a diameter > 5 mm or use anticoagulant therapy (even lifelong) in the case of the largest diameter of fistula, because of a high risk of a blood clot in the dilated segment of closed fistula. Fig. 1 Pulmonary valve stenosis in a 11-month-old baby. A) Right ventriculography (LAO 28 + cranial 29 projection). B) Lateral projection. C) During balloon valvuloplasty with Valver balloon catheter (15 mm/4 cm) still visible waist in the place of stenosis. ... In conclusion, the congress was a significant event, concerning difficult questions and an experience exchange forum, which was held in the beautiful and very hospitable country of Vietnam.

We describe a patient who, at the age of 6 months (body weight 6.1 kg), was diagnosed with a large atrial septal defect (with diameter 10–11 mm) that had spontaneously closed in a 1-year period. The timing of transcatheter intervention in children should be considered individually, paying close attention to subsequent echocardiographic data.

Transcatheter closure of single secundum atrial defects has become the standard of treatment. The purpose of our study was to analyze the results of using a single Amplatzer device for closure of double atrial septal defects. Such defects were diagnosed in 41 out of 363 patients with atrial septal defects (ASDs) closed by transcatheter method. In 39, a single Amplatzer device was used. The size of the larger defect ranged from 5 to 18 mm, the smaller defect from 2 to 7 mm, with the distance between the borders of the communications ranging from 2 to 12 mm. We performed sizing and closure of only the larger defect. The mean size of implanted devices was 16.5 ± 5.5 mm, equal to the stretched diameter of the main defect or 1–4 mm larger. The closure rate assessed by color Doppler flow examination was 61% after 24 hr, 78% after 1 month, 83% after 3 months, 86% after 1 year, and 95% after 2 years. If the distance between the two defects exceeded 7 mm, residual leaks were observed but tended to decrease and disappear with time. Selected patients with double atrial septal defects can be effectively treated with implantation of a single Amplatzer device. Catheter Cardiovasc Interv 2004;61:237–241. © 2004 Wiley-Liss, Inc.

Two cases are presented. In the first patient (8-year-old boy) after Glenn operation without closure of pulmonary outflow from the common ventricle (SV-PA) despite transcatheter SV-PA closure increased mean pulmonary artery pressure (mPAP) (22 mm Hg) remained. After 6 months of sildenafil therapy he was catheterized again. His mPAP dropped to 10 mm Hg and a Fontan operation was subsequently performed. The second patient was a 25-year-old man, 20 years after a Fontan operation, presenting protein los ing enteropathy and severe heart failure. All syndromes diminished significantly after medical therapy with sildenafil. Good clinical results of sildenafil therapy were maintained after 1 and 4 years of treatment. Chronic therapy with sildenafil can be beneficial in patients before and after the Fontan operation with elevated pulmonary artery pressure.