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Background: The suspected etiology of superior vena cava (SVC) obstruction is predominantly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, although there is a paucity of published data in pediatrics. We aim to describe patient characteristics and clinical outcomes after transcatheter SVC intervention at a single-center pediatric quaternary care center. Methods: Single-center, retrospective study of all pediatric and young adult patients who underwent transcatheter SVC intervention from December 2006 to January 2020. SVC gradients and changes in vessel diameter were compared using paired-sample t-tests. Balloon and stent cohorts were compared using the Wilcoxon rank sum test or Fisher exact χ2 test. Reintervention was compared between balloon and stent cohorts using the McNemar test to determine if initial procedural type was associated with reintervention. Time to reintervention was compared between balloon vs stent cohorts using Kaplan-Meier survival analysis with a log-rank test. Results: A total of 42 patients (median age, 1.5 years; IQR, 0.31-15; 64.2% male) underwent 81 procedures with 1 minor complication and no mortality attributed to the procedure. Most (71.4%) patients were asymptomatic. Affected patient subgroups include those with a history of central venous line (92.9%), congenital heart disease (76.2%), postorthotopic heart transplant (42.9%), post-ECMO (31.0%), and history of surgical baffling or SVC surgery (9.5%). Those who underwent initial balloon angioplasty were significantly younger and smaller than those with an initial stent. Significantly lower pressure gradients and larger SVC dimensions were achieved after stenting. The majority of patients (54.8%) resolved after initial balloon angioplasty and reintervention rates were similar between initial balloon angioplasty and stent, although reintervention trended toward being earlier after the balloon. Conclusions: Transcatheter SVC intervention in pediatrics is acutely effective and safe in relieving SVC obstruction in all subgroups. Reintervention rates are similar between balloon and stenting, with balloon tending to be earlier, with the majority resolving after initial intervention. Further research is necessary to investigate the most effective transcatheter intervention for each patient subgroup.

Background: Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, utilizing either a staged repair (SR) or primary repair (PR) approach. They are exposed to several sources of low-dose ionizing radiation, which may contribute to increased cancer risk. Objectives: The purpose of this study was to compare cumulative radiation exposure and associated lifetime attributable risk (LAR) of cancer between treatment strategies in sTOF. Methods: Neonates with sTOF who underwent SR or PR from 2012 to 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Radiation exposure from all radiologic studies prior to 18 months of age was converted to organ-equivalent doses and projected LAR of cancer incidence using the National Cancer Institute dosimetry tools. Results: There were 242 neonates from 8 centers, including patients with 146 SR and 96 PR. Cumulative total effective dose was significantly higher for SR (median 8.3 mSv, IQR: 3.0-17.4 mSv) than PR (2.1 mSv, IQR: 0.8-8.5 mSv; P 1 mGy in females, the LAR was highest for breast in SR (mean 1.9/1,000 patients). The highest proportion of cancers attributable to radiation exposure was projected for thyroid cancer in females undergoing SR (7.3%). Conclusions: Cumulative radiation exposure and LARs were higher among those undergoing SR compared to PR. This will be an important factor to consider in determining the preferred neonatal treatment strategy and should substantiate efforts to reduce radiation exposure in this vulnerable population.

Previous studies have used cardiopulmonary exercise test (CPET) data to objectively assess physiological changes in patients undergoing percutaneous pulmonary valve implantation. A retrospective review was performed to assess pre- and post-CPET data among patients undergoing Alterra Adaptive Prestent and SAPIEN 3 transcatheter heart valve (Alterra) placement. Of the 7 patients eligible for the study, 5 (71%) were male. The mean age was 22 years (range: 12-49 years). CPET data showed significant (P = 0.03) improvement in ventilatory efficiency (VE/VCO2) while only 2 (29%) patients had an improvement of percent predicted peak oxygen consumption (VO2). These findings suggest favourable haemodynamic changes though further investigation is needed. Résumé: Des résultats aux épreuves d’effort cardiorespiratoire ont été utilisés lors d’études antérieures pour mesurer de manière objective les changements physiologiques chez les patients ayant subi l’implantation percutanée d’une valvule pulmonaire. Nous présentons une étude rétrospective des résultats à ces épreuves avant et après l’intervention dans des cas d’implantation transcathéther d’une prothèse Alterra Adaptive Prestent et d’une valve cardiaque SAPIEN 3 (Alterra). Parmi les sept patients admissibles à l’étude, cinq (71 %) étaient de sexe masculin. L’âge moyen des sujets était de 22 ans (plage de 12 à 49 ans). Les résultats obtenus à l’épreuve d’effort cardiorespiratoire ont démontré une amélioration significative (P = 0,03) de l’efficacité respiratoire (VE/VCO2), mais seulement deux patients (29 %) ont présenté une amélioration du pourcentage prévu de la consommation maximale d’oxygène (VO2). Bien que ces observations semblent indiquer des changements hémodynamiques favorables, d’autres études sont nécessaires pour élucider la question.

Background: Numerous studies have detailed outcomes of Transcatheter pulmonary valve placement (TPV) in young patients, but there is a paucity of data in older patients. We sought to evaluate short and mid-term outcomes of TPV in patients older than 40 years of age. Methods: Retrospective multicenter study of patients older than 40 years at the time of TPV from January 2010 to February 2018. Demographics, procedure details, and follow up data were collected. Results: A total 75 subjects presented for TPV with median age of 49.8 (IQ 45–60). Half of the patients 39 (52%) had evidence of NYHA class III or IV at time of presentation. A total of 65 (87%) had successful TPV. Patients with severe PR had immediate resolution of PI (except for one). Patients with PS had significant improvement in gradient from median of 25.5 to 5.5 mmHg (p